Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure

Aims: Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS). The aim of this study was to analyse the prevalence of subclinical pulmonary congestion at discharge and its impact on prognosis in pati...

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Autores: Rivas-Lasarte, Mercedes, Maestro, Alba, Fernandez-Martinez, Juan, Lopez-Lopez, Laura, Sole-Gonzalez, Eduard, Vives-Borras, Miquel, Montero, Santiago, Mesado, Nuria, Pirla, Maria J, Mirabet, Sonia, Fluvia, Paula, Brossa, Vicens, Sionis, Alessandro, Roig, Eulalia, Cinca, Juan, Alvarez-Garcia, Jesus
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Instituto de Salud Carlos III (ISCIII)
Repositorio:Repisalud
Idioma:inglés
OAI Identifier:oai:repisalud.isciii.es:20.500.12105/23056
Acceso en línea:https://hdl.handle.net/20.500.12105/23056
Access Level:acceso abierto
Palabra clave:Heart failure
Lung ultrasound
Pulmonary congestion
Prognosis
Insuficiencia Cardíaca
Humanos
Prevalencia
Pronóstico
Pulmón
Alta del Paciente
Lung
Humans
Patient Discharge
Prevalence
Heart Failure
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spelling Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failureRivas-Lasarte, MercedesMaestro, AlbaFernandez-Martinez, JuanLopez-Lopez, LauraSole-Gonzalez, EduardVives-Borras, MiquelMontero, SantiagoMesado, NuriaPirla, Maria JMirabet, SoniaFluvia, PaulaBrossa, VicensSionis, AlessandroRoig, EulaliaCinca, JuanAlvarez-Garcia, JesusHeart failureLung ultrasoundPulmonary congestionPrognosisInsuficiencia CardíacaHumanosPrevalenciaPronósticoPulmónAlta del PacientePrognosisLungHumansPatient DischargePrevalenceHeart FailureAims: Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS). The aim of this study was to analyse the prevalence of subclinical pulmonary congestion at discharge and its impact on prognosis in patients admitted for acute HF. Methods and results: This is a post-hoc analysis of the LUS-HF trial. LUS was performed by the investigators in eight chest zones with a pocket device. Physical exam was subsequently performed by the treating physicians. Primary outcome was a combined endpoint of rehospitalization, unexpected visit for HF worsening or death at 6- month follow-up. Subclinical pulmonary congestion at discharge was defined as the presence of >= 5 B-lines in LUS in absence of rales in the auscultation employing the area under the ROC curve. At discharge, 100 patients (81%) did not show clinical signs of pulmonary congestion. of these, 41 had >= 5 B-lines. Independent factors related with the presence of subclinical pulmonary congestion were anaemia, higher New York Heart Association (NYHA) class, and N terminal pro brain natriuretic peptide (NT-proBNP). After adjusting by propensity score analysis including age, renal insufficiency, atrial fibrillation, NYHA class, NT-proBNP levels, clinical congestion, and the trial intervention, the presence of subclinical pulmonary congestion at discharge was a risk factor for the occurrence of the primary outcome (hazard ratio 2.63; 95% confidence interval: 1.08-6.41;P = 0.033). Conclusions: Up to 40% of patients considered 'dry' according to pulmonary auscultation presents subclinical congestion at hospital discharge that can be detected by LUS and implies a worse prognosis at 6- month follow-up. Comorbidities, high values of natriuretic peptides, and higher NYHA class are the factors related with its presence.Wiley20242024-09-1320202020-10-0120202020-10-01research articlehttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articlehttps://hdl.handle.net/20.500.12105/23056reponame:Repisaludinstname:Instituto de Salud Carlos III (ISCIII)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repisalud.isciii.es:20.500.12105/230562026-06-12T12:43:37Z
dc.title.none.fl_str_mv Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
title Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
spellingShingle Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
Rivas-Lasarte, Mercedes
Heart failure
Lung ultrasound
Pulmonary congestion
Prognosis
Insuficiencia Cardíaca
Humanos
Prevalencia
Pronóstico
Pulmón
Alta del Paciente
Prognosis
Lung
Humans
Patient Discharge
Prevalence
Heart Failure
title_short Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
title_full Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
title_fullStr Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
title_full_unstemmed Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
title_sort Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
dc.creator.none.fl_str_mv Rivas-Lasarte, Mercedes
Maestro, Alba
Fernandez-Martinez, Juan
Lopez-Lopez, Laura
Sole-Gonzalez, Eduard
Vives-Borras, Miquel
Montero, Santiago
Mesado, Nuria
Pirla, Maria J
Mirabet, Sonia
Fluvia, Paula
Brossa, Vicens
Sionis, Alessandro
Roig, Eulalia
Cinca, Juan
Alvarez-Garcia, Jesus
author Rivas-Lasarte, Mercedes
author_facet Rivas-Lasarte, Mercedes
Maestro, Alba
Fernandez-Martinez, Juan
Lopez-Lopez, Laura
Sole-Gonzalez, Eduard
Vives-Borras, Miquel
Montero, Santiago
Mesado, Nuria
Pirla, Maria J
Mirabet, Sonia
Fluvia, Paula
Brossa, Vicens
Sionis, Alessandro
Roig, Eulalia
Cinca, Juan
Alvarez-Garcia, Jesus
author_role author
author2 Maestro, Alba
Fernandez-Martinez, Juan
Lopez-Lopez, Laura
Sole-Gonzalez, Eduard
Vives-Borras, Miquel
Montero, Santiago
Mesado, Nuria
Pirla, Maria J
Mirabet, Sonia
Fluvia, Paula
Brossa, Vicens
Sionis, Alessandro
Roig, Eulalia
Cinca, Juan
Alvarez-Garcia, Jesus
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Heart failure
Lung ultrasound
Pulmonary congestion
Prognosis
Insuficiencia Cardíaca
Humanos
Prevalencia
Pronóstico
Pulmón
Alta del Paciente
Prognosis
Lung
Humans
Patient Discharge
Prevalence
Heart Failure
topic Heart failure
Lung ultrasound
Pulmonary congestion
Prognosis
Insuficiencia Cardíaca
Humanos
Prevalencia
Pronóstico
Pulmón
Alta del Paciente
Prognosis
Lung
Humans
Patient Discharge
Prevalence
Heart Failure
description Aims: Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS). The aim of this study was to analyse the prevalence of subclinical pulmonary congestion at discharge and its impact on prognosis in patients admitted for acute HF. Methods and results: This is a post-hoc analysis of the LUS-HF trial. LUS was performed by the investigators in eight chest zones with a pocket device. Physical exam was subsequently performed by the treating physicians. Primary outcome was a combined endpoint of rehospitalization, unexpected visit for HF worsening or death at 6- month follow-up. Subclinical pulmonary congestion at discharge was defined as the presence of >= 5 B-lines in LUS in absence of rales in the auscultation employing the area under the ROC curve. At discharge, 100 patients (81%) did not show clinical signs of pulmonary congestion. of these, 41 had >= 5 B-lines. Independent factors related with the presence of subclinical pulmonary congestion were anaemia, higher New York Heart Association (NYHA) class, and N terminal pro brain natriuretic peptide (NT-proBNP). After adjusting by propensity score analysis including age, renal insufficiency, atrial fibrillation, NYHA class, NT-proBNP levels, clinical congestion, and the trial intervention, the presence of subclinical pulmonary congestion at discharge was a risk factor for the occurrence of the primary outcome (hazard ratio 2.63; 95% confidence interval: 1.08-6.41;P = 0.033). Conclusions: Up to 40% of patients considered 'dry' according to pulmonary auscultation presents subclinical congestion at hospital discharge that can be detected by LUS and implies a worse prognosis at 6- month follow-up. Comorbidities, high values of natriuretic peptides, and higher NYHA class are the factors related with its presence.
publishDate 2020
dc.date.none.fl_str_mv 2020
2020-10-01
2020
2020-10-01
2024
2024-09-13
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.12105/23056
url https://hdl.handle.net/20.500.12105/23056
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv reponame:Repisalud
instname:Instituto de Salud Carlos III (ISCIII)
instname_str Instituto de Salud Carlos III (ISCIII)
reponame_str Repisalud
collection Repisalud
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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