Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
ESC Heart Fail. 2022 Oct;9(5):3044-3051. doi: 10.1002/ehf2.14041. Epub 2022 Jun 23.
We aim to investigate the additive effect of B-lines on lung ultrasound (LUS) for predicting outcome in patients with heart failure (HF) when combined with conventional assessment of clinical congestion.
This study prospectively enrolled 117 hospitalized HF patients (61 ± 16 years, 70.1% males) who underwent congestion assessment by the 'wet/dry' status, clinical congestion score (CCS), and B-lines on LUS. The primary endpoint was all-cause mortality or hospitalization for HF during the 180-day follow-up after discharge. The 'Wet', CCS ≥ 3, and B-lines >5, indicators of congestion positive (+), were observed in 83.8%, 76.1%, and 70.1% of the patients on admission, respectively; and the numbers significantly decreased to 41.9%, 41.9%, and 35.9% at discharge, respectively. The agreement between the 'wet/dry' status and B-lines (58.1%) or between CCS and B-lines (56.4%) was moderate at discharge, in terms of both positive and both negative. By incorporating the B-lines with assessment of clinical congestion, the patients at discharge were divided into three phenotypes as clinical congestion (+), clinical congestion (-) with B-lines (+), and clinical congestion (-) with B-lines (-). The Kaplan-Meier analysis showed a better survival in the both (-) group ('wet/dry' with B-lines: Chi-square 10.591, P = 0.005; CCS with B-lines: χ 6.239, P = 0.031). When the 'wet' patients (n = 49) being taken as the reference, the 'dry' patients with B-lines (+) (n = 21) had an identical risk of the composite endpoint (hazard ratio [HR] adjusted for clinical covariates 1.021, 95% confidence interval [CI] 0.480-2.134, P = 0.974), while the 'dry' patients with B-lines (-) (n = 47) had a lower risk (HR 0.264, 95% CI 0.113-0.617, P = 0.002). When the CCS (+) patients (n = 49) being regarded as the reference, similar results were obtained in the patients with CCS (-) but B-lines (+) (n = 22) (HR 1.348, 95% CI 0.627-2.896, P = 0.444) as well as in those with both CCS (-) and B-lines (-) (n = 46) (HR 0.447, 95% CI 0.202-0.992, P = 0.048).
The combination of B-lines on LUS and conventional assessment helped to identify new phenotypes of congestion that aid in the risk stratification of discharged HF patients. Further investigation is warranted to determine whether this strategy could be adopted as a guide for decongestion therapy.
本研究旨在探讨肺部超声（LUS）中 B 线对心力衰竭（HF）患者预后的预测价值，并将其与临床充血评估相结合。
本前瞻性研究纳入了 117 例住院 HF 患者（61±16 岁，70.1%为男性），他们在出院后 180 天的随访期间接受充血评估，评估方法为“干湿”状态、临床充血评分（CCS）和 LUS 上的 B 线。主要终点为全因死亡率或 HF 再住院。入院时，分别有 83.8%、76.1%和 70.1%的患者出现充血阳性（+）的“湿/干”状态、CCS≥3 和 B 线>5；出院时，这些指标分别显著下降至 41.9%、41.9%和 35.9%。“湿/干”状态与 B 线（58.1%）或 CCS 与 B 线（56.4%）之间的一致性在出院时为中度，无论是阳性还是阴性均为中度。通过将 B 线与临床充血评估相结合，出院患者被分为三种表型：临床充血（+）、临床充血（-）伴 B 线（+）和临床充血（-）伴 B 线（-）。Kaplan-Meier 分析显示，两组（“湿/干”伴 B 线：卡方 10.591，P=0.005；CCS 伴 B 线：χ 2=6.239，P=0.031）均为（-）的患者生存率更好。当“湿”患者（n=49）作为参考时，B 线阳性的“干”患者（n=21）的复合终点风险相同（校正临床混杂因素的 HR 1.021，95%CI 0.480-2.134，P=0.974），而 B 线阴性的“干”患者（n=47）的风险较低（HR 0.264，95%CI 0.113-0.617，P=0.002）。当 CCS（+）患者（n=49）作为参考时，在 CCS（-）但 B 线（+）的患者（n=22）（HR 1.348，95%CI 0.627-2.896，P=0.444）和 CCS（-）和 B 线（-）的患者（n=46）（HR 0.447，95%CI 0.202-0.992，P=0.048）中也获得了类似的结果。
LUS 上 B 线与传统评估相结合有助于识别新的充血表型，有助于 HF 出院患者的风险分层。需要进一步研究以确定这种策略是否可以作为充血治疗的指导。
