Author + information
- Received June 7, 2019
- Revision received July 22, 2019
- Accepted July 23, 2019
- Published online September 30, 2019.
- Elke Platz, MD, MSa,b,∗∗ (, )
- Ross T. Campbell, MBChBc,∗,
- Brian Claggett, PhDb,d,
- Eldrin F. Lewis, MD, MPHb,d,
- John D. Groarke, MD, MPHb,d,
- Kieran F. Docherty, MBChBc,
- Matthew M.Y. Lee, MBChBc,
- Allison A. Merz, BAa,b,
- Montane Silverman, BAa,b,
- Varsha Swamy, BSa,b,
- Moritz Lindner, MDa,b,
- Jose Rivero, MDb,d,
- Scott D. Solomon, MDb,d and
- John J.V. McMurray, MBChB, MDc
- aDepartment of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- bHarvard Medical School, Boston, Massachusetts
- cBritish Heart Foundation (BHF) Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- dCardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Elke Platz, Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, Massachusetts 02115.
Objectives This study sought to assess the prevalence, changes in, and prognostic importance of B-lines, a pulmonary congestion measure by using a simplified lung ultrasonography (LUS) method in acute heart failure (AHF).
Background Pulmonary congestion is an important finding in AHF, but conventional methods for its detection are insensitive.
Methods In a 2-site, prospective, observational study, 4-zone LUS was performed early during hospitalization for AHF (LUS1) and at discharge (LUS2). B-lines were quantified off-line, blinded to clinical findings and outcomes, by a core laboratory.
Results Among 349 patients (median, 75 years of age; 59% men; mean ejection fraction 39%), the sum of B-lines in 4 zones ranged from 0 to 18 (LUS1). The risk of an adverse in-hospital event increased with rising number of B-lines on LUS1: the odds ratio for each B-line tertile was 1.82 (95% confidence interval [CI]: 1.14 to 2.88; p = 0.011). B-line count decreased from a median of 6 (LUS1) to 4 (LUS2; p < 0.001) over 6 days (median). In 132 patients with LUS2 images, the risk of HF hospitalization or all-cause death was greater in patients with a higher number of B-lines at discharge. This relationship was stronger closer to discharge: unadjusted hazard ratio (HR) at 60 days was 3.30 (95% CI: 1.52 to 7.17; p = 0.002); 2.94 at 90 days (95% CI: 1.46 to 5.93; p = 0.003); and 2.01 at 180 days (95% CI: 1.11 to 3.64; p = 0.021). The association between number of B-lines and short- and long-term outcomes persisted after adjusting for important clinical variables, including N-terminal pro–B-type natriuretic peptide.
Conclusions Pulmonary congestion using a simplified 4-zone LUS method was common in patients with AHF and improved with therapy. A higher number of B-lines at baseline and discharge identified patients at increased risk for adverse events.
↵∗ Drs. Platz and Campbell contributed equally to this work and are joint first authors.
Supported by U.S. National Institutes of Health/National Heart, Lung and Blood Institute (NIH/NHLB) grant K23HL123533) (to Dr. Platz) and project grant PG/13/17/30050 (to Drs. Campbell and McMurray) from the British Heart Foundation. Dr. Platz has received research support from NIH/NHLBI. Dr. Groarke has received research support from Amgen Pharmaceuticals. Dr. Solomon has received research support from and personal fees from Alnylam, Amgen, AstraZeneca, Bellerophon, Bristol-Myers Squibb, Celladon, Gilead, GlaxoSmithKline, Ionis, Lone Star Heart, Mesoblast, MyoKardia, NIH/NHLBI, Novartis, and Sanofi Pasteur, Theracos; and has received personal fees from Akros, Bayer, Corvia, Ironwood, Merck, Pfizer, Roche, Takeda, Theracos, Quantum Genetics, AoBiome, Janssen, and Cardiac Dimensions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 7, 2019.
- Revision received July 22, 2019.
- Accepted July 23, 2019.
- 2019 American College of Cardiology Foundation
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