Peak B-lines during exercise stress echocardiography independently predicted cardiovascular death or HF hospitalization at 1 year in HFpEF patients (HR 1.50 per 1 B-line increment; 95% CI 1.21-1.85; P<0.001).
Cohort (n=61)
Does detection of exercise-induced pulmonary congestion by lung ultrasound predict cardiovascular death or heart failure hospitalization in patients with HFpEF?
Assessment of exercise-induced pulmonary congestion via lung ultrasound B-lines provides independent prognostic value for cardiovascular death or heart failure hospitalization in patients with HFpEF.
Hazard Ratio: 1.5 (95% CI 1.21–1.85)
p-value: p=<0.001
Background: Patients with heart failure (HF) with preserved ejection fraction (HFpEF) typically develop dyspnea and pulmonary congestion upon exercise. Lung ultrasound is a simple diagnostic tool, providing semiquantitative assessment of extravascular lung water through B-lines. It has been shown that patients with HFpEF develop B-lines upon submaximal exercise stress echocardiography; however, whether exercise-induced pulmonary congestion carries prognostic implications is unknown. This study aimed at evaluating the prognostic value of B-line assessment during exercise in patients with HFpEF. Methods: Sixty-one New York Heart Association class I to II patients with HFpEF underwent standard echocardiography, lung ultrasound (28-scanning point method), and BNP (B-type natriuretic peptide) assessment during supine exercise echocardiography (baseline and peak exercise). The primary end point was a composite of cardiovascular death or HF hospitalization at 1 year. Results: B-lines, E/e′, and BNP significantly increased during exercise ( P <0.001 for all). By multivariable analysis, both peak (hazard ratio, 1.50 95% CI, 1.21–1.85, P <0.001), and change (hazard ratio 1.34 95% CI, 1.12–1.62, P =0.002) B-lines were retained as independent predictors of outcome (hazard ratios per 1 B-line increment), along with BNP and E/e′ ratio. Importantly, adding peak B-line on top of a clinical model significantly improved prognostic accuracy (C-index increase, 0.157 0.056–0.258, P =0.002) and net reclassification (continuous net reclassification improvement, 0.51 0.09–0.74, P =0.016), with similar results for B-line change. Conclusions: Detection of exercise-induced pulmonary congestion by lung ultrasound is an independent predictor of outcome in patients with HFpEF; its use may help refining the routine risk stratification of these patients on top of well-established clinical variables.
Coiro et al. (Mon,) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=61). Peak B-lines during exercise stress echocardiography was evaluated on Composite of cardiovascular death or HF hospitalization at 1 year (HR 1.50, 95% CI 1.21-1.85, p=<0.001). Peak B-lines during exercise stress echocardiography independently predicted cardiovascular death or HF hospitalization at 1 year in HFpEF patients (HR 1.50 per 1 B-line increment; 95% CI 1.21-1.85; P<0.001).