Lung ultrasound for the evaluation of pulmonary congestion in outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography

The aim of this study was to define the performance of lung ultrasound (LUS) compared with clinical assessment, natriuretic peptides, and echocardiography, to evaluate decompensation in patients with systolic heart failure (HF) in an outpatient clinic. Evaluation of pulmonary congestion in chronic H...

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Bibliographic Details
Published in:JACC. Cardiovascular imaging 2013-11, Vol.6 (11), p.1141-1151
Main Authors: Miglioranza, Marcelo Haertel, Gargani, Luna, Sant'Anna, Roberto Tofani, Rover, Marciane Maria, Martins, Vitor Magnus, Mantovani, Augusto, Weber, Cristina, Moraes, Maria Antonieta, Feldman, Carlos Jader, Kalil, Renato Abdala Karam, Sicari, Rosa, Picano, Eugenio, Leiria, Tiago Luiz Luz
Format: Article
Language:English
Subjects:
Adult
Aged
Biomarkers - blood
Chronic Disease
Cohort Studies
Echocardiography, Doppler
Exercise Test
Female
Heart Failure, Systolic - blood
Heart Failure, Systolic - complications
Heart Failure, Systolic - diagnosis
Heart Failure, Systolic - diagnostic imaging
Humans
Lung - diagnostic imaging
Male
Middle Aged
Natriuretic Peptide, Brain - blood
Outpatients
Peptide Fragments - blood
Predictive Value of Tests
Prognosis
Pulmonary Edema - blood
Pulmonary Edema - diagnosis
Pulmonary Edema - diagnostic imaging
Pulmonary Edema - etiology
ROC Curve
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Summary:The aim of this study was to define the performance of lung ultrasound (LUS) compared with clinical assessment, natriuretic peptides, and echocardiography, to evaluate decompensation in patients with systolic heart failure (HF) in an outpatient clinic. Evaluation of pulmonary congestion in chronic HF is challenging. LUS has been recently proposed as a reliable tool for the semiquantification of extravascular lung water through assessment of B-lines. This was a cohort study of patients with moderate to severe systolic HF. Receiver-operating characteristic (ROC) analyses were performed to compare LUS with a previously validated clinical congestion score (CCS), amino-terminal portion of B-type natriuretic peptide (NT-proBNP), E/e' ratio, chest x-ray, and 6-min walk test. Ninety-seven patients were enrolled. Decompensation was present in 57.7% of patients when estimated by CCS, 68% by LUS, 53.6% by NT-proBNP, and 65.3% by E/e' ≥15. The number of B-lines was correlated to NT-proBNP (r = 0.72; p < 0.0001), E/e' (r = 0.68; p < 0.0001), and CCS (r = 0.43; p < 0.0001). In ROC analyses, considering as reference for decompensation a combined method (E/e' ≥ 15 and/or NT-proBNP >1,000 pg/ml), LUS yielded a C-statistic of 0.89 (95% confidence interval: 0.82 to 0.96), providing the best accuracy with a cutoff ≥ 15 B-lines (sensitivity 85%, specificity 83%). A systematic approach using CCS, E/e', NT-proBNP, chest x-ray, and 6-min walk test in different combinations as reference for decompensation also corroborated this cutoff and found a similar accuracy for LUS. In an HF outpatient clinic, B-lines were significantly correlated with more established parameters of decompensation. A B-line ≥15 cutoff could be considered for a quick and reliable assessment of decompensation in outpatients with HF.
ISSN:1876-7591
DOI:10.1016/j.jcmg.2013.08.004