Coronary Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan 14030, México City, Mexico.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Wolfe Street 615, Baltimore 21205, Maryland, USA.
QJM. 2021 Apr 27;114(2):111-116. doi: 10.1093/qjmed/hcaa298.
B-lines have been associated with adverse clinical outcomes in patients with heart failure (HF) when found at hospital discharge or during outpatient visits. Whether lung ultrasound (LUS) assessed B-lines may predict in-hospital mortality in patients with acute HF is still undetermined.
To evaluate the association between B-lines on admission and in-hospital mortality among patients admitted with acute HF.
Hand-held LUS was used to examine patients with acute HF. LUS was performed in eight chest zones with a pocket ultrasound device and analyzed offline. The association between B-lines and in-hospital mortality was assessed using Cox regression models.
We included 62 patients with median age 56 years, 69.4% men, and median left ventricle ejection fraction 25%. The sum of B-lines ranged from 0 to 53 (median 6.5). An optimal receiver operating characteristic-determined cut-off of ≥19 B-lines demonstrated a sensitivity of 57% and a specificity of 86% (area under the curve 0.788) for in-hospital mortality. The incremental prognostic value of LUS when compared with lung crackles or peripheral edema by integrated discrimination improvement was 12.96% (95% CI: 7.0-18.8, P = 0.02). Patients with ≥19 B-lines had a 4-fold higher risk of in-hospital mortality (HR 4.38; 95% CI: 1.37-13.95, P < 0.01).
In patients admitted with acute HF, point-of-care LUS measurements of pulmonary congestion (B-lines) are associated with in-hospital mortality.
在心力衰竭（HF）患者出院时或门诊就诊时发现 B 线与不良临床结局相关。肺部超声（LUS）评估 B 线是否可预测急性 HF 患者的住院死亡率仍不确定。
评估急性 HF 患者入院时 B 线与住院期间死亡率之间的关系。
使用手持式 LUS 检查急性 HF 患者。使用口袋式超声设备对 8 个胸部区域进行 LUS 检查，并离线进行分析。使用 Cox 回归模型评估 B 线与住院死亡率之间的关系。
我们纳入了 62 名年龄中位数为 56 岁、69.4%为男性、左心室射血分数中位数为 25%的急性 HF 患者。B 线总数范围为 0 至 53（中位数为 6.5）。通过最佳受试者工作特征曲线确定的≥19 个 B 线的截断值显示出对住院死亡率的敏感性为 57%，特异性为 86%（曲线下面积为 0.788）。与肺部爆裂音或外周水肿相比，LUS 增加的预后价值通过综合判别改善为 12.96%（95%CI：7.0-18.8，P=0.02）。B 线≥19 个的患者住院死亡率的风险增加了 4 倍（HR 4.38；95%CI：1.37-13.95，P<0.01）。
在因急性 HF 住院的患者中，即时肺部充血（B 线）的 LUS 测量值与住院死亡率相关。
