Prognostic impact of lung ultrasound detected B-lines on hospitalised ischaemic heart failure with mildly reduced ejection fraction patients

Hui Zhang; Yuying Zhou; Fangqun Cheng; Yunlong Zhu; Na Li; Xin Peng; Mingxin Wu; Haobo Huang; Lingling Zhang; Min Liao; Sha Xiao; Yongliang Chen; Sihao Chen; Zhican Liu; Liqing Yi; Jie Fan; Jianping Zeng

doi:10.1136/openhrt-2023-002480

Prognostic impact of lung ultrasound detected B-lines on hospitalised ischaemic heart failure with mildly reduced ejection fraction patients

Open Heart. 2023 Dec 7;10(2):e002480. doi: 10.1136/openhrt-2023-002480.

Authors

Hui Zhang^#^{1

2}, Yuying Zhou^#^{1

2}, Fangqun Cheng^#³, Yunlong Zhu^{4

5}, Na Li^{1

2}, Xin Peng^{1

2}, Mingxin Wu¹, Haobo Huang¹, Lingling Zhang¹, Min Liao¹, Sha Xiao¹, Yongliang Chen^{1

2}, Sihao Chen^{1

2}, Zhican Liu¹, Liqing Yi¹, Jie Fan¹, Jianping Zeng⁶

Affiliations

¹ Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China.
² University of South China, Hengyang, Hunan, China.
³ Xiangtan Central Hospital, Xiangtan, Hunan, China.
⁴ Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China xhjiang2@hnust.edu.cn zhuyunlong@stu.cpu.edu.cn.
⁵ Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
⁶ Xiangtan Central Hospital, Xiangtan, Hunan, China xhjiang2@hnust.edu.cn zhuyunlong@stu.cpu.edu.cn.

^# Contributed equally.

Abstract

Objectives: Prognostic impact of lung ultrasound-derived B-lines (LUS-BL) in heart failure with mildly reduced left ventricular ejection fraction (HFmrEF) patients remains elusive. We evaluated the correlation between LUS-BL and prognosis in HFmrEF patients.

Methods: This is a subgroup analysis based on our previously published retrospective study with 1691 HFmrEF patients. This subgroup analysis involved 574 patients with LUS-BL results at admission. After discharge, patients underwent clinical follow-up for a minimum of 1 year through telephone, clinical visits or community visits. The primary endpoint was defined as cardiovascular (CV) event, including CV-related mortality or HF hospitalisation at 90 days and 1 year after discharge.

Results: CV event at 90 days was significantly increased with higher LUS-BL number (0, 1-2, 3-9 and ≥10: 20%, 14%, 18% and 33%, p=0.008), while CV event rate at 1 year was similar among groups (45% vs 45% vs 42% vs 50%, p=0.573). Older age, hypertension (HR=2.06, 95% CI 1.31 to 3.25), higher right ventricular diameter (>23 mm, HR=2.008, 95% CI 1.37 to 2.94), increased ratio of early transmitral flow velocity to early mitral annular velocity (>24, HR=1.79, 95% CI 1.11 to 2.26) and higher LUS-BL number (>11, HR=1.510, 95% CI 1.01 to 2.26) were identified as independent determinants associated with increased risk of CV event at 90 days after discharge. The Harrell's C-Statistic analysis, based on the Cox regression models, demonstrated a significant improvement in the predictive ability of the model that incorporated both clinical and echocardiographic risk factors along with LUS-BL (areas under the curve (AUC)=0.72) compared with the model comprising only clinical risk factors and LUS-BL (AUC=0.69, p=0.036), or to the model with echocardiographic risk factors and LUS-BL (AUC=0.68, p=0.025).

Conclusion: In HFmrEF patients with ischaemic heart disease, admission LUS-BL>11 is independently associated with an increased risk of CV event at 90 days following discharge.

Keywords: Diagnostic Imaging; Heart Failure; Heart Failure, Systolic.

MeSH terms

Heart Failure*
Humans
Lung / diagnostic imaging
Prognosis
Retrospective Studies
Stroke Volume
Ventricular Dysfunction, Left*
Ventricular Function, Left