Heart failure, pulmonary hypertension and heart transplant division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
Heart failure, pulmonary hypertension and heart transplant division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
Am Heart J. 2024 Nov;277:47-57. doi: 10.1016/j.ahj.2024.07.015. Epub 2024 Jul 31.
The optimal assessment of systemic and lung decongestion during acute heart failure is not clearly defined. We evaluated whether inferior vena cava (IVC) and pulmonary ultrasound (CAVAL US) guided therapy is superior to standard care in reducing subclinical congestion at discharge in patients with AHF.
CAVAL US-AHF was an investigator-initiated, single-center, single-blind, randomized controlled trial. A daily quantitative ultrasound protocol using the 8-zone method was used and treatment was adjusted according to an algorithm. The primary endpoint was the presence of more than 5 B-lines and/or an increase in IVC diameter and collapsibility at discharge. And secondary endpoint exploratory outcome was the composite of readmission for HF, unplanned visit for worsening HF or death at 90 days RESULTS: Sixty patients were randomized to CAVAL US (n = 30) or control (n = 30). The primary endpoint was achieved in 4 patients (13.3%) in the CAVAL US group and 20 patients (66.6%) in the control group (P < .001). A significant reduction in HF readmission, unplanned visit for worsening HF or death at 90 days was seen in the CAVAL US group (13.3% vs 36.7%; log rank P = .038). Other endpoints such as NT-proBNP reduction at discharge showed a nonstatistically significant reduction in the CAVAL US group (48% IQR 27-67 vs 37% -3-59; P = .09). Safety outcomes were similar in both groups.
IVC and lung ultrasound-guided therapy in AHF patients significantly reduced subclinical congestion at discharge. CAVAL US-AHF provides preliminary evidence for the potential use of a simple technique to guide decongestive therapy during hospitalization for AHF, which may reduce the composite outcome at 90 days.
急性心力衰竭（AHF）患者的系统性和肺充血的最佳评估方法尚不清楚。我们评估了下腔静脉（IVC）和肺部超声（CAVAL US）指导治疗是否优于标准治疗，以减少 AHF 患者出院时亚临床充血。
CAVAL US-AHF 是一项由研究者发起的、单中心、单盲、随机对照试验。采用 8 区定量超声方案，根据算法调整治疗。主要终点是出院时存在超过 5 条 B 线和/或 IVC 直径和塌陷增加。次要终点探索性结果是 90 天内因 HF 再入院、HF 恶化计划外就诊或死亡的复合结果。
60 例患者被随机分为 CAVAL US 组（n = 30）和对照组（n = 30）。CAVAL US 组有 4 例（13.3%）达到主要终点，对照组有 20 例（66.6%）（P <.001）。CAVAL US 组 HF 再入院、HF 恶化计划外就诊或死亡的发生率显著降低（13.3%比 36.7%；对数秩检验 P =.038）。其他终点如出院时 NT-proBNP 降低，CAVAL US 组也显示出非统计学意义的降低（48% IQR 27-67 比 37% -3-59；P =.09）。两组的安全性结局相似。
在 AHF 患者中，IVC 和肺部超声指导治疗显著降低了出院时的亚临床充血。CAVAL US-AHF 为一种简单的技术在 AHF 住院期间指导充血治疗的潜在应用提供了初步证据，可能降低 90 天的复合结局。
