Cardiovascular R&D Centre-UnIC@RISE, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto, Porto, Portugal.
Internal Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Clin Res Cardiol. 2024 Mar;113(3):425-432. doi: 10.1007/s00392-023-02238-9. Epub 2023 Jun 8.
Lung congestion is frequent in heart failure (HF) and is associated with symptoms and poor prognosis. Lung ultrasound (LUS) identification of B-lines may help refining congestion assessment on top of usual care. Three small trials comparing LUS-guided therapy to usual care in HF suggested that LUS-guided therapy could reduce urgent HF visits. However, to our knowledge, the usefulness of LUS in influencing loop diuretic dose adjustment in ambulatory chronic HF has not been studied.
To study whether to show or not LUS results to the HF assistant physician would change loop diuretic adjustments in "stable" chronic ambulatory HF patients.
Prospective randomised single-blinded trial comparing two strategies: (1) open 8-zone LUS with B-line results available to clinicians, or (2) blind LUS. The primary outcome was change in loop diuretic dose (up- or down-titration).
A total of 139 patients entered the trial, 70 were randomised to blind LUS and 69 to open LUS. The median (percentile) age was 72 (63-82) years, 82 (62%) were men, and the median LVEF was 39 (31-51) %. Randomisation groups were well balanced. Furosemide dose changes (up- and down-titration) were more frequent among patients in whom LUS results were open to the assistant physician: 13 (18.6%) in blind LUS vs. 22 (31.9%) in open LUS, OR 2.55, 95%CI 1.07-6.06. Furosemide dose changes (up- and down-titration) were more frequent and correlated significantly with the number of B-lines when LUS results were open (Rho = 0.30, P = 0.014), but not when LUS results were blinded (Rho = 0.19, P = 0.13). Compared to blind LUS, when LUS results were open, clinicians were more likely to up-titrate furosemide dose if the result "presence of pulmonary congestion" was identified and more likely to decrease furosemide dose in the case of an "absence of pulmonary congestion" result. The risk of HF events or cardiovascular death did not differ by randomisation group: 8 (11.4%) in blind LUS vs. 8 (11.6%) in open LUS.
Showing the results of LUS B-lines to assistant physicians allowed more frequent loop diuretic changes (both up- and down-titration), which suggests that LUS may be used to tailor diuretic therapy to each patient congestion status.
充血性心力衰竭（HF）中经常出现肺部充血，与症状和预后不良相关。肺部超声（LUS）识别 B 线可能有助于在常规护理的基础上完善充血评估。三项比较 LUS 引导治疗与 HF 常规护理的小型试验表明，LUS 引导治疗可减少紧急 HF 就诊。然而，据我们所知，LUS 对影响门诊慢性 HF 中袢利尿剂剂量调整的作用尚未得到研究。
研究向 HF 助理医师展示或不展示 LUS 结果是否会改变“稳定”慢性门诊 HF 患者的袢利尿剂调整。
前瞻性随机单盲试验比较两种策略：（1）开放 8 区 LUS 并向临床医生提供 B 线结果，或（2）盲法 LUS。主要结局是袢利尿剂剂量的变化（增加或减少滴定）。
共有 139 例患者入组，70 例随机分为盲法 LUS 组，69 例开放 LUS 组。中位（百分位数）年龄为 72（63-82）岁，82 例（62%）为男性，中位 LVEF 为 39（31-51）%。随机分组组间均衡。在 LUS 结果向助理医师开放的情况下，接受 LUS 治疗的患者中呋塞米剂量的变化（增加和减少滴定）更为频繁：盲法 LUS 组 13 例（18.6%），开放 LUS 组 22 例（31.9%），OR 2.55，95%CI 1.07-6.06。当 LUS 结果开放时，呋塞米剂量的变化（增加和减少滴定）更为频繁，与 B 线数量显著相关（Rho=0.30，P=0.014），但当 LUS 结果为盲法时则不相关（Rho=0.19，P=0.13）。与盲法 LUS 相比，如果结果为“存在肺部充血”，则 LUS 结果开放时临床医生更有可能增加呋塞米的剂量；如果结果为“不存在肺部充血”，则更有可能减少呋塞米的剂量。随机分组组间 HF 事件或心血管死亡的风险无差异：盲法 LUS 组 8 例（11.4%），开放 LUS 组 8 例（11.6%）。
向助理医师展示 LUS B 线结果可使袢利尿剂的变化（增加和减少滴定）更为频繁，这表明 LUS 可用于根据每位患者充血状态调整利尿剂治疗。
