Residual subclinical pulmonary congestion at discharge was associated with a higher risk of mortality, HF re-hospitalization, or worsening kidney disease (81% vs 36.8%; HR 2.62, 95% CI 1.5-54.7).
Cohort (n=112)
No
Does residual subclinical congestion at discharge increase the risk of adverse outcomes in patients hospitalized for acute heart failure?
Residual subclinical congestion at discharge, detected via non-invasive techniques like lung ultrasound, is independently associated with a significantly higher risk of adverse clinical outcomes in acute heart failure patients.
Hazard Ratio: 2.62 (95% CI 1.5–54.7)
Tasa de eventos absoluta: 81% vs 36.8%
valor p: p=<0.001
Abstract Background Recent evidence suggests that residual subclinical pulmonary congestion (SBC) at discharge in patients hospitalized for acute heart failure (HF) may be significantly associated with adverse events. However, data on real-world patients remain limited. Purpose We aim to analyze the association between residual SBC at discharge - evaluated through non-invasive techniques (lung ultrasound LUS, echocardiography ECD, plasma levels of natriuretic peptides)- and major adverse outcomes in patients hospitalized for acute HF. Methods This was a single-center prospective cohort study of acute HF patients requiring intravenous diuretic administration, admitted to our Cardiology Unit from January 2023 to October 2024. SBC at discharge was defined by the presence of at least one of the following criteria: 1. Three or more B-lines in two or more symmetric pulmonary zones with/without pleural effusion. 2. Evidence of at least two out of three indirect markers of elevated left ventricular filling pressures (E/e’ 14, TR velocity 2.8 m/s, LA-rs 18%) or at least two markers of elevated right-sided filling pressures/right heart dysfunction (IVC diameter 21 mm and/or collapsibility 50%, TR velocity 2.8 m/s, RVfWLS 13.1%). 3. A reduction of less than 36% reduction in BNP levels between admission and discharge (i.e. delta BNP). The primary endpoint was a composite of all-cause mortality, re-hospitalizations for acute HF, worsening stage of chronic kidney disease or the need of renal replacement therapy. Results A total of 112 patients were consecutively enrolled (median age: 73 years; 63.7% male). At discharge, SBC was detected in 26 patients (23%). After a median follow-up of 299 days IQR 128-414, a total of 53 events of the composite outcome occurred. As shown in Figure 1, patients with SBC had a significantly higher rate of the composite endpoint (81% vs 36.8%, p0.001) At the Cox regression analysis, the presence of SBC was independently associated with a higher risk of the composite outcome even after adjusting for eGFR at discharge, age and sex (HR 2.62, 95% CI 1.5-54.7). Residual SBC was also associated with a higher risk of all-cause mortality (HR 2.46, 95% CI 0.98-6.13, p= 0.05). Finally, ROC curves (Figure 2) were used to assess the accuracy of LUS, delta BNP and ECD in predicting the composite outcome. The presence of SBC on LUS showed the highest AUC (0.699) compared with delta BNP (AUC 0.649) and ECD parameters (AUC 0.557). Conclusions The presence of residual SBC at discharge was independently associated with a higher risk of adverse clinical outcome. Identifying HF patients with SBC through non-invasive techniques readily available in routine clinical practice, may help clinicians optimize medical therapy, improve clinical outcomes, and refine follow-up strategies.Kaplan Meier Curves ROC Curves
Manicardi et al. (Sat,) conducted a cohort in Acute heart failure (n=112). Residual subclinical pulmonary congestion (SBC) at discharge vs. Absence of SBC at discharge was evaluated on Composite of all-cause mortality, re-hospitalizations for acute HF, worsening stage of chronic kidney disease or the need of renal replacement therapy (HR 2.62, 95% CI 1.5-54.7, p=<0.001). Residual subclinical pulmonary congestion at discharge was associated with a higher risk of mortality, HF re-hospitalization, or worsening kidney disease (81% vs 36.8%; HR 2.62, 95% CI 1.5-54.7).