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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Authors: Rivas-Lasarte, Mercedes, Maestro, Alba, Fernández-Martínez, Juan, López-López, Laura, Solé-González, Eduard, Vives-Borras, Miquel, Montero, Santiago, Mesado, Nuria, Pirla, María J., Mirabet, Sonia, Fluvià Brugues, Paula, Brossa, Vicens, Sionis, Alessandro, Roig, Eulàlia, Cinca, Juan, Álvarez-García, Jesus
Format: article
Status:Published version
Publication Date:2020
Country:España
Institution:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repository:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/45570
Online Access:http://hdl.handle.net/10230/45570
http://dx.doi.org/10.1002/ehf2.12842
Access Level:Open access
Keyword:Heart failure
Lung ultrasound
Prognosis
Pulmonary congestion
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spelling Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failureRivas-Lasarte, MercedesMaestro, AlbaFernández-Martínez, JuanLópez-López, LauraSolé-González, EduardVives-Borras, MiquelVives-Borras, MiquelMontero, SantiagoMesado, NuriaPirla, María J.Mirabet, SoniaFluvià Brugues, PaulaBrossa, VicensSionis, AlessandroRoig, EulàliaCinca, JuanÁlvarez-García, JesusHeart failureLung ultrasoundPrognosisPulmonary congestionAims: 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.Wiley202020202020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/45570http://dx.doi.org/10.1002/ehf2.12842reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésCopyright © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.http://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10230/455702026-05-29T05:05:01Z
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
Prognosis
Pulmonary congestion
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
Fernández-Martínez, Juan
López-López, Laura
Solé-González, Eduard
Vives-Borras, Miquel
Vives-Borras, Miquel
Montero, Santiago
Mesado, Nuria
Pirla, María J.
Mirabet, Sonia
Fluvià Brugues, Paula
Brossa, Vicens
Sionis, Alessandro
Roig, Eulàlia
Cinca, Juan
Álvarez-García, Jesus
author Rivas-Lasarte, Mercedes
author_facet Rivas-Lasarte, Mercedes
Maestro, Alba
Fernández-Martínez, Juan
López-López, Laura
Solé-González, Eduard
Vives-Borras, Miquel
Montero, Santiago
Mesado, Nuria
Pirla, María J.
Mirabet, Sonia
Fluvià Brugues, Paula
Brossa, Vicens
Sionis, Alessandro
Roig, Eulàlia
Cinca, Juan
Álvarez-García, Jesus
author_role author
author2 Maestro, Alba
Fernández-Martínez, Juan
López-López, Laura
Solé-González, Eduard
Vives-Borras, Miquel
Montero, Santiago
Mesado, Nuria
Pirla, María J.
Mirabet, Sonia
Fluvià Brugues, Paula
Brossa, Vicens
Sionis, Alessandro
Roig, Eulàlia
Cinca, Juan
Álvarez-García, Jesus
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Heart failure
Lung ultrasound
Prognosis
Pulmonary congestion
topic Heart failure
Lung ultrasound
Prognosis
Pulmonary congestion
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
2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/45570
http://dx.doi.org/10.1002/ehf2.12842
url http://hdl.handle.net/10230/45570
http://dx.doi.org/10.1002/ehf2.12842
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by-nc/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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