Key result
Combined ultrasound congestion assessment linked to ~40-fold higher mortality and HF readmission risk.
Why the study?
The study was conducted to evaluate the prognostic value for total mortality and repeated hospitalization of ultrasound diagnostic methods in patients with acute decompensated heart failure.
Do ultrasound diagnostic methods (lung ultrasound, VExUS, liver elastometry) predict mortality and HF readmission in patients with acute decompensated heart failure?
Cohort (n=207)
Do ultrasound diagnostic methods (lung ultrasound, VExUS, liver elastometry) predict mortality and HF readmission in patients with acute decompensated heart failure?
Hazard Ratio: 40.1 (95% CI 6.6–243.1)
p-value: p=< 0.001
A multi-organ ultrasound approach combining lung ultrasound, VExUS, and liver elastometry at discharge provides strong independent prognostic value for mortality and readmission in patients with acute decompensated heart failure.
May identify higher-risk HF patients; leaves open incremental value beyond standard assessment.
Objectives:To evaluate the prognostic value (total mortality + repeated hospitalization for heart failure (HF)) of ultrasound diagnostic methods in patients with acute decompensated HF (ADHF). Methods: The subjects were patients with chronic HF, who were hospitalized for ADHF. Using ultrasound methods—lung ultrasound, ultrasound assessment of hepatic venous congestion as per the venous excess ultrasound (VExUS) protocol, and indirect elastometry—we assessed the number of B-lines, hepatic venous congestion, and liver density of the patients. Clinical outcomes were assessed using a structured telephone survey method at 1, 3, 6, and 12 months after discharge. Combined overall mortality and readmission rates associated with HF were assessed. Threshold values for different methods for detecting congestion were set as follows: the number of B-lines in ultrasound data > 5; liver density > 6.2 kPa. Results: The subjects were 207 patients (54.1% male; mean age = 70.7 ± 12.8 years). A total of 63 (30.4%) endpoints and 23 (11.1%) deaths were detected within 364 days (IQR = 197–365). Liver density > 6.2 kPa had a hazard ratio (HR) of 1.9 ( 95% CI: 1.0–3.3; p =0.029). Hepatic venous congestion (VExUS protocol) had HR of 2.8 (95% CI: 1.3–5.7; p =0.004). There was a significant increase in the risk of overall prognostic value in the presence of congestion, identified by liver fibroelastometry + lung ultrasound (HR = 10.5, 95% CI: 2.3–46.2; p =0.002). The ultrasound assessment of hepatic venous congestion (VExUS + lung ultrasound protocol) yielded HR of 16.7 (95% CI: 3.9–70.7; p < 0.001). For all three methods combined, the overall HR was 40.1 (95% CI: 6.6–243.1; p < 0.001). Conclusions: A combination of ultrasound diagnostic methods that include the number of B-lines, presence of hepatic venous congestion according to the VExUS protocol, and liver density according to indirect elastometry at discharge may have an independent prognostic value for patients with ADHF.
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Kobalava et al. (2024) conducted a cohort in Acute decompensated heart failure (n=207). Combined ultrasound assessment of congestion (lung ultrasound, VExUS protocol, liver elastometry) vs. Absence of congestion was evaluated on Combined overall mortality and readmission rates associated with HF (HR 40.1, 95% CI 6.6-243.1, p=< 0.001). Combined ultrasound assessment of congestion (B-lines, VExUS, liver density) strongly predicted mortality and heart failure readmission (HR 40.1; 95% CI 6.6-243.1; p<0.001).
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