Maestro-Benedicto Alba, Rivas-Lasarte Mercedes, Fernández-Martínez Juan, López-López Laura, Solé-González Eduard, Brossa Vicens, Mirabet Sonia, Roig Eulàlia, Cinca Juan, Álvarez-García Jesús, Sionis Alessandro
Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain.
Cardiology Department, Hospital Universitario Puerta de Hierro CIBERCV, Majadahonda Madrid, Spain.
Front Physiol. 2022 Sep 14;13:1006589. doi: 10.3389/fphys.2022.1006589. eCollection 2022.
Over the last decades, several scores have been developed to aid clinicians in assessing prognosis in patients with heart failure (HF) based on clinical data, medications and, ultimately, biomarkers. Lung ultrasound (LUS) has emerged as a promising prognostic tool for patients when assessed at discharge after a HF hospitalization. We hypothesized that contemporary HF risk scores can be improved upon by the inclusion of the number of B-lines detected by LUS at discharge to predict death, urgent visit, or HF readmission at 6- month follow-up. We evaluated the discrimination improvement of adding the number of B-lines to 4 contemporary HF risk scores (Get with the Guidelines -GWTG-, MAGGIC, Redin-SCORE, and BCN Bio-HF) by comparing the change in the area under the receiver operating curve (AUC), the net reclassification index (NRI), and the integrated discrimination improvement (IDI). The population of the study was constituted by the 123 patients enrolled in the LUS-HF trial, adjusting the analyses by the intervention. The AUC of the GWTG score increased from 0.682 to 0.789 ( = 0.02), resulting in a NRI of 0.608 and an IDI of 0.136 ( < 0.05). Similar results were observed when adding the number of B-lines to the MAGGIC score, with an AUC that increased from 0.705 to 0.787 ( < 0.05). This increase translated into a NRI of 0.608 and an IDI of 0.038 ( < 0.05). Regarding Redin-SCORE at 1-month and 1-year, the AUC increased from 0.714 to 0.773 and from 0.681 to 0.757, although it did not reach statistical significance ( = 0.08 and = 0.06 respectively). Both IDI and NRI were significantly improved (0.093 and 0.509 in the 1-month score, < 0.05; 0.056 and 0.111 in the 1-year score, < 0.05). Lastly, the AUC for the BCN Bio-HF score increased from 0.733 to 0.772, which was statistically non-significant, with a NRI value of 0.363 ( = 0.06) and an IDI of 0.092 ( < 0.05). Adding the results of LUS evaluated at discharge improved the predictive value of most of the contemporary HF risk scores. As it is a simple, fast, and non-invasive test it may be recommended to assess prognosis at discharge in HF patients.
在过去几十年中，已经开发了多种评分系统，以帮助临床医生根据临床数据、药物治疗以及最终的生物标志物来评估心力衰竭（HF）患者的预后。肺超声（LUS）已成为HF住院患者出院时评估预后的一种有前景的工具。我们假设，通过纳入出院时LUS检测到的B线数量来预测6个月随访时的死亡、紧急就诊或HF再入院情况，可以改进当代HF风险评分。我们通过比较接受者操作特征曲线下面积（AUC）、净重新分类指数（NRI）和综合鉴别改善（IDI）的变化，评估了将B线数量添加到4种当代HF风险评分（遵循指南 -GWTG-、MAGGIC、Redin-SCORE和BCN Bio-HF）中的鉴别改善情况。该研究人群由123名参加LUS-HF试验的患者组成，并根据干预措施对分析进行调整。GWTG评分的AUC从0.682增加到0.789（P = 0.02），NRI为0.608，IDI为0.136（P < 0.05）。将B线数量添加到MAGGIC评分中也观察到了类似结果，AUC从0.705增加到0.787（P < 0.05）。这种增加转化为NRI为0.608，IDI为0.038（P < 0.05）。关于1个月和1年时的Redin-SCORE评分，AUC分别从0.714增加到0.773以及从0.681增加到0.757，尽管未达到统计学显著性（分别为P = 0.08和P = 0.06）。IDI和NRI均有显著改善（1个月评分时分别为0.093和0.509，P < 0.05；1年评分时分别为0.056和0.111，P < 0.05）。最后，BCN Bio-HF评分的AUC从0.733增加到0.772，无统计学显著性，NRI值为0.363（P = 0.06），IDI为0.092（P < 0.05）。添加出院时评估的LUS结果改善了大多数当代HF风险评分的预测价值。由于它是一种简单、快速且无创的检查，可能推荐用于评估HF患者出院时的预后。
