Key result
Over 15 lung ultrasound B-lines linked to ~21-fold higher adverse event risk in newly diagnosed HFpEF.
Why the study?
Lung ultrasound is a promising tool in heart failure, but more information was needed on its value in predicting outcomes in ambulatory patients with newly diagnosed HFpEF.
Does lung ultrasound assessment of B-lines predict adverse outcomes in ambulatory patients with newly diagnosed HFpEF?
Cohort (n=75)
No
Does lung ultrasound assessment of B-lines predict adverse outcomes in ambulatory patients with newly diagnosed HFpEF?
Lung ultrasound assessment of B-lines (>15) is a strong, independent predictor of adverse outcomes in newly diagnosed HFpEF, performing similarly to NT-proBNP.
Answers are grounded in this paper and cite their sources.
B-lines may aid risk stratification in new HFpEF; leaves open whether ultrasound-guided therapy improves outcomes.
Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed. Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting. Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death. Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at >15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 ( p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p < 0.001). Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.
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Morvai-Illés et al. (2021) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=75). Lung ultrasound (LUS) > 15 B-lines vs. ≤ 15 B-lines was evaluated on Composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death (HR 20.956, p=0.004). Having more than 15 B-lines on lung ultrasound increased the risk of adverse events in patients with newly diagnosed HFpEF, with a.956.
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