Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
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 a...
| Autores: | , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2020 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:238785 |
| Acceso en línea: | https://ddd.uab.cat/record/238785 https://dx.doi.org/urn:doi:10.1002/ehf2.12842 |
| Access Level: | acceso abierto |
| Palabra clave: | Heart failure Lung ultrasound Pulmonary congestion Prognosis |
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Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failureRivas-Lasarte, Mercedes|||0000-0002-8704-3104Maestro, Alba|||0000-0003-1785-3125Fernández Martínez, Juan|||0000-0002-2011-2136López López, Laura|||0000-0002-8653-6206Solé González, Eduard|||0000-0002-5727-9925Vives-Borrás, Miquel|||0000-0002-5345-4124Montero, Santiago|||0000-0002-0984-3472Mesado, NuriaPirla, Maria JoséMirabet Pérez, Sonia|||0000-0001-5955-2748Fluvià, Paula|||0000-0002-4683-9122Brossa Loidi, Vicens|||0000-0003-0403-6425Sionis, Alessandro|||0000-0003-0843-9512Roig, Eulàlia|||0000-0002-3421-4985Cinca, Juan|||0000-0003-4819-4265Alvarez-Garcia, Jesus|||0000-0002-2015-6446Heart failureLung ultrasoundPulmonary congestionPrognosisResidual 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. 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). 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.Universitat Autònoma de Barcelona 22020-01-0120202020-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/238785https://dx.doi.org/urn:doi:10.1002/ehf2.12842reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengInstituto de Salud Carlos III https://doi.org/10.13039/501100004587 CM17-00028Ministerio de Economía y Competitividad https://doi.org/10.13039/501100003329 CB16-11-00276open accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2387852026-06-06T12:50:31Z |
| 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|||0000-0002-8704-3104 Heart failure Lung ultrasound Pulmonary congestion Prognosis |
| 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|||0000-0002-8704-3104 Maestro, Alba|||0000-0003-1785-3125 Fernández Martínez, Juan|||0000-0002-2011-2136 López López, Laura|||0000-0002-8653-6206 Solé González, Eduard|||0000-0002-5727-9925 Vives-Borrás, Miquel|||0000-0002-5345-4124 Montero, Santiago|||0000-0002-0984-3472 Mesado, Nuria Pirla, Maria José Mirabet Pérez, Sonia|||0000-0001-5955-2748 Fluvià, Paula|||0000-0002-4683-9122 Brossa Loidi, Vicens|||0000-0003-0403-6425 Sionis, Alessandro|||0000-0003-0843-9512 Roig, Eulàlia|||0000-0002-3421-4985 Cinca, Juan|||0000-0003-4819-4265 Alvarez-Garcia, Jesus|||0000-0002-2015-6446 |
| author |
Rivas-Lasarte, Mercedes|||0000-0002-8704-3104 |
| author_facet |
Rivas-Lasarte, Mercedes|||0000-0002-8704-3104 Maestro, Alba|||0000-0003-1785-3125 Fernández Martínez, Juan|||0000-0002-2011-2136 López López, Laura|||0000-0002-8653-6206 Solé González, Eduard|||0000-0002-5727-9925 Vives-Borrás, Miquel|||0000-0002-5345-4124 Montero, Santiago|||0000-0002-0984-3472 Mesado, Nuria Pirla, Maria José Mirabet Pérez, Sonia|||0000-0001-5955-2748 Fluvià, Paula|||0000-0002-4683-9122 Brossa Loidi, Vicens|||0000-0003-0403-6425 Sionis, Alessandro|||0000-0003-0843-9512 Roig, Eulàlia|||0000-0002-3421-4985 Cinca, Juan|||0000-0003-4819-4265 Alvarez-Garcia, Jesus|||0000-0002-2015-6446 |
| author_role |
author |
| author2 |
Maestro, Alba|||0000-0003-1785-3125 Fernández Martínez, Juan|||0000-0002-2011-2136 López López, Laura|||0000-0002-8653-6206 Solé González, Eduard|||0000-0002-5727-9925 Vives-Borrás, Miquel|||0000-0002-5345-4124 Montero, Santiago|||0000-0002-0984-3472 Mesado, Nuria Pirla, Maria José Mirabet Pérez, Sonia|||0000-0001-5955-2748 Fluvià, Paula|||0000-0002-4683-9122 Brossa Loidi, Vicens|||0000-0003-0403-6425 Sionis, Alessandro|||0000-0003-0843-9512 Roig, Eulàlia|||0000-0002-3421-4985 Cinca, Juan|||0000-0003-4819-4265 Alvarez-Garcia, Jesus|||0000-0002-2015-6446 |
| author2_role |
author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Universitat Autònoma de Barcelona |
| dc.subject.none.fl_str_mv |
Heart failure Lung ultrasound Pulmonary congestion Prognosis |
| topic |
Heart failure Lung ultrasound Pulmonary congestion Prognosis |
| description |
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. 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). 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 |
2 2020-01-01 2020 2020-01-01 |
| dc.type.none.fl_str_mv |
Article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
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article |
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https://ddd.uab.cat/record/238785 https://dx.doi.org/urn:doi:10.1002/ehf2.12842 |
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https://ddd.uab.cat/record/238785 https://dx.doi.org/urn:doi:10.1002/ehf2.12842 |
| dc.language.none.fl_str_mv |
Inglés eng |
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Inglés |
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eng |
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Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 CM17-00028 Ministerio de Economía y Competitividad https://doi.org/10.13039/501100003329 CB16-11-00276 |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by-nc/4.0/ |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by-nc/4.0/ |
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openAccess |
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application/pdf |
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