The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

Blanka Morvai-Illés; Nóra Polestyuk-Németh; István Adorján Szabó; Magdolna Monoki; Luna Gargani; Eugenio Picano; Albert Varga; Gergely Ágoston

doi:10.3389/fcvm.2021.758147

The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

Front Cardiovasc Med. 2021 Dec 2:8:758147. doi: 10.3389/fcvm.2021.758147. eCollection 2021.

Authors

Blanka Morvai-Illés¹, Nóra Polestyuk-Németh², István Adorján Szabó³, Magdolna Monoki¹, Luna Gargani⁴, Eugenio Picano⁴, Albert Varga¹, Gergely Ágoston¹

Affiliations

¹ Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary.
² Emergency Patient Care Unit, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary.
³ Mures County Clinical Hospital, Cardiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania.
⁴ Institute of Clinical Physiology, National Research Council, Pisa, Italy.

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed. Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting. Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death. Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at >15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 (p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p < 0.001). Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.

Keywords: diagnosis; echocardiography; heart failure with preserved ejection fraction (HFpEF); lung ultrasonography (LUS); prognosis.