Ye Xiao-Jun, Li Nan, Li Jia-Hui, Wu Wen-Jing, Li Ai-Li, Li Xian-Lun
Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.
Echocardiography. 2019 Jul;36(7):1253-1262. doi: 10.1111/echo.14420. Epub 2019 Jul 9.
B-line imaging by lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. The aim of this study was to explore the prognostic value of B-line number at admission in predicting symptomatic heart failure (HF) during hospitalization in acute anterior wall STEMI patients.
This was a prospective cohort study which consecutively enrolled 96 anterior wall STEMI patients without dyspnea at admission. Pulmonary auscultation, NT-proBNP test, LUS, and echocardiography were performed within 5 hours after primary PCI. Rale occurrence, plasma NT-proBNP levels, B-line number, LVEF, E/e' were recorded, and their predictive value for HF in-hospital was analyzed.
A total of 19 patients developed symptomatic HF. Median B-line number, NT-proBNP levels, and E/e' in the HF group were higher than those of the nonheart-failure (NHF) group (P < 0.001) while LVEF was lower (P = 0.002). There was no statistical difference in rale occurrence between the two groups. Multivariate logistic regression demonstrated that B-lines, E/e', and NT-proBNP independently predicted HF during hospitalization. According to the area under the ROC curve, the strongest predictor is B-lines (0.972), followed by NT-proBNP (0.936) and E/e' (0.928), and combining the three indicators was better than any single parameter (P = 0.048). B-line cutoff ≥18 could well predict HF event with specificity and sensitivity of 94.7% and 94.8%, respectively.
Subclinical pulmonary congestion reflected by B-lines can independently predict symptomatic HF during hospitalization in patients with anterior wall STEMI, LUS will act as a complementary tool for evaluating cardiac function.
肺部超声（LUS）的B线成像技术是评估亚临床肺充血的一种新工具。本研究旨在探讨急性前壁ST段抬高型心肌梗死（STEMI）患者入院时B线数量对预测住院期间症状性心力衰竭（HF）的预后价值。
这是一项前瞻性队列研究，连续纳入96例入院时无呼吸困难的前壁STEMI患者。在直接经皮冠状动脉介入治疗（PCI）后5小时内进行肺部听诊、N末端B型利钠肽原（NT-proBNP）检测、LUS和超声心动图检查。记录啰音出现情况、血浆NT-proBNP水平、B线数量、左心室射血分数（LVEF）、E/A比值，并分析它们对住院期间HF的预测价值。
共有19例患者发生症状性HF。HF组的B线数量中位数、NT-proBNP水平和E/A比值高于非心力衰竭（NHF）组（P<0.001），而LVEF较低（P=0.002）。两组间啰音出现情况无统计学差异。多因素逻辑回归分析表明，B线、E/A比值和NT-proBNP可独立预测住院期间的HF。根据ROC曲线下面积，最强的预测指标是B线（0.972），其次是NT-proBNP（0.936）和E/A比值（0.928），三项指标联合使用优于任何单一参数（P=0.048）。B线截断值≥18可较好地预测HF事件，特异性和敏感性分别为94.7%和94.8%。
B线反映的亚临床肺充血可独立预测前壁STEMI患者住院期间的症状性HF，LUS将成为评估心功能的辅助工具。
