Subclinical pulmonary congestion provides further risk stratification in heart failure patients at discharge

Background It is well accepted that heart failure (HF) patients with clinically overt congestion at discharge have a higher risk of events in post-discharge vulnerable period. However, it was yet clear regarding the prognostic value of subclinical pulmonary congestion that detected by the two upcoming tools as lung ultrasound (LUS) and Remote Dielectric Sensing (ReDS). Purpose To investigate if the assessment of LUS or ReDS combined with Clinical Congestion Score (CCS) improves risk stratification at discharge. Methods This study prospectively enrolled 208 patients (63[54, 74] years, 68.8% male) with acute decompensated HF. Within 24 hours before discharge, they underwent concurrent CCS assessment, LUS B-line and and ReDS measurement. CCS positive (+) was defined as a CCS score >2, ReDS (+) as a value >35%, B-line (+) as the presence of >5 comets by the 28-zone methodology. Subclinical pulmonary congestion was recognized if CCS (-) but ReDS (+) or B-line (+). Patients were followed up for all-cause mortality or HF rehospitalization as the composite primary endpoint in 90 days. Results 92 (44.2%) patients were CCS (+), 101 (48.6%) were ReDS (+), and 124 (59.6%) were B-line (+), respectively. Only 4 patients were lost to follow up, while 10 patients (4.9%) died (all cardiovascular causes) and 43 (21.1%) had HF rehospitalization. There were 47 (23.0%) patients who reached the primary composite endpoint. Patients with a positive measurement were associated with an increased risk of the endpoint (Unadjusted HR: CCS 3.13[1.74-5.63], ReDS 2.49[1.38-4.52], B-line 4.05[2.15-7.64], all Log-rank P < 0.01). Notably, patients with subclinical pulmonary congestion exhibited higher risks comparable to those with clinical congestion as CCS (+). In contrast, the absence of subclinical congestion on top of CCS (-) showed a significantly lower risk (Figure 1 and Figure 2). After adjusted for age, gender, NYHA class, left ventricular ejection fraction and log-transformed NT-proBNP, it still remained independently associated with a lower risk (Adjusted HR: CCS-/ReDS- 0.29 [0.15–0.57]; CCS-/B-line- 0.16 [0.07–0.38]). Conclusion Integrated assessment of residual congestion status at discharge, by using LUS or ReDS for identification of subclinical pulmonary congestion combined with conventional clinical evaluation, provided a better post-discharge risk stratification in HF patients.