Takagi Ryu, Kobayashi Masatake, Kuwahara Asuka, Takihara Kazuya, Yamashita Yuki, Deguchi Haruyuki, Nukariya Masato, Nagamatsu Yuki, Nakayama Tomoaki, Kitamura Miki, Tezuka Taiyo, Ikeda Kazumasa, Kazawa Shuichiro, Ito Ryosuke, Iwasaki Yoichi, Yamada Satoshi, Gargani Luna, Duarte Kevin, Kubo Takashi, Satomi Kazuhiro, Girerd Nicolas, Tanaka Nobuhiro
Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan; Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.
Int J Cardiol. 2025 Nov 1;438:133599. doi: 10.1016/j.ijcard.2025.133599. Epub 2025 Jul 5.
Patients with acute pulmonary edema (APE) requiring an urgent heart failure (HF) hospitalization face poor prognosis largely due to pulmonary congestion. We aimed at assessing the patterns and variations of pulmonary congestion associated with different assessments of congestion and prognosis.
This prospective study included patients with APE who underwent lung ultrasound (8-zone B-lines method) and echocardiography immediately after emergency department visit, with follow-up assessments on days 2, 3, 7, and discharge. B-type natriuretic peptide (BNP) levels were measured at admission, day 7, and discharge. The associations between B-line changes, other congestion marker changes and outcomes were assessed.
Among 137 patients (mean age: 77 ± 13 years; 61 % male), 71 % had New York Heart Association IV, 65 % had left ventricular ejection fraction <45 %, and median B-lines were 44 (32-58) on admission. While B-lines showed no association with other congestion markers at admission, they correlated significantly with pulmonary artery systolic pressure (PASP) from day 2 to discharge, and with E/e´ and BNP at day 7 and discharge. Throughout hospitalization, B-line changes consistently correlated with changes in other congestion markers (E/e´, PASP, and BNP) (all-p-values<0.05). Among congestion markers, B-lines showed the most prominent reduction from admission to day 2, and this reduction was associated with a lower risk of all-cause mortality or HF rehospitalization over a median 217-day follow-up (adjusted-HR, 95 %CI = 0.96, 0.94-0.99; p = 0.01).
In APE, B-lines lacked association with other congestion markers immediately after hospitalization. However, B-lines decreased noticeably from admission to day 2, with changes correlating with other markers and prognosis.
因急性肺水肿（APE）而需紧急住院治疗心力衰竭（HF）的患者预后较差，主要原因是肺充血。我们旨在评估与不同充血评估及预后相关的肺充血模式和变化情况。
这项前瞻性研究纳入了APE患者，这些患者在急诊科就诊后立即接受了肺部超声检查（8区B线法）和超声心动图检查，并在第2天、第3天、第7天和出院时进行随访评估。在入院时、第7天和出院时测量B型利钠肽（BNP）水平。评估B线变化、其他充血标志物变化与预后之间的关联。
在137例患者（平均年龄：77±13岁；61%为男性）中，71%患有纽约心脏协会IV级心力衰竭，65%的左心室射血分数<45%，入院时B线中位数为44（32 - 58）条。入院时B线与其他充血标志物无关联，但从第2天至出院，B线与肺动脉收缩压（PASP）显著相关，在第7天和出院时与E/e´及BNP显著相关。在整个住院期间，B线变化始终与其他充血标志物（E/e´、PASP和BNP）的变化相关（所有p值<0.05）。在充血标志物中，B线从入院到第2天下降最为显著，在中位217天的随访中，这种下降与全因死亡率或HF再住院风险较低相关（校正风险比，95%置信区间=0.96，0.94 - 0.99；p = 0.01）。
在APE患者中，住院后即刻B线与其他充血标志物无关联。然而，从入院到第2天B线明显下降，其变化与其他标志物及预后相关。
