Prognostic value of lung ultrasound in chronic stable ambulatory heart failure patients.

INTRODUCTION AND OBJECTIVES: The role of lung ultrasound (LUS) in acute heart failure (HF) has been widely studied, but little is known about its usefulness in chronic HF. This study assessed the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients. METHODS: We included consecutive outpatients who attended a scheduled follow-up visit in a HF clinic. LUS was performed in situ. The operators were blinded to clinical data and examined 8 thoracic areas. The sum of B-lines across all lung zones and the quartiles of this addition were used for the analyses. Linear regression and Cox regression analyses were performed. The main clinical outcomes were a composite of all-cause death or hospitalization for HF and mortality from any cause. RESULTS: A total of 577 individuals were included (72% men; 69± 12 years). The mean number of B-lines was 5±6. During a mean follow-up of 31±7 months, 157 patients experienced the main clinical outcome and 111 died. Having ≥ 8 B-lines (Q4) doubled the risk of experiencing the composite primary event (P <.001) and increased the risk of death from any cause by 2.6-fold (P <.001). On multivariate analysis, the total sum of B-lines remained independent predictive factor of the composite endpoint (HR, 1.04; 95%CI, 1.02-1.06; P=.002) and of all-cause death (HR, 1.04; 95%CI, 1.02-1.07; P=.001), independently of whether or not N-terminal pro-B-type natriuretic peptide (NT-proBNP) was included in the model (P=.01 and P=.008, respectively), with a 3% to 4% increased risk for each 1-line addition. CONCLUSIONS: LUS identified patients with stable chronic HF at high risk of death or HF hospitalization.

Lung ultrasound in heart failure. / Ecografía pulmonar en la insuficiencia cardiaca.

The present article reviews the usefulness of lung ultrasound in the diagnosis, prognostic stratification and treatment of patients with heart failure. The article addresses the technical aspects when performing lung ultrasonography, as well as the importance of the presence of B-lines in the diagnosis and the prognostic value of pulmonary congestion. Moreover, the article reviews the most recently published evidence on the use of lung ultrasound in heart failure. Lastly, the article references the new clinical trials currently underway, including the EPICC study conducted jointly by the Heart Failure and Clinical Ultrasonography Workgroups of the Spanish Society of Internal Medicine.

Diagnóstico de neumonía por ultrasonido en el servicio de urgencias / Diagnosis of pneumonia by ultrasound at emergency room

Resumen Comunicamos el caso clínico de un paciente de 54 años de edad que ingresó al servicio por dificultad respiratoria. Inició su padecimiento actual un mes previo a su ingreso con tos productiva con expectoración purulenta abundante, fiebre no cuantificada y pérdida de peso, dos días previos a su ingreso se agregó dificultad respiratoria que se exacerbó aproximadamente tres horas previas a su ingreso. A la exploración física se observó paciente consciente con signos vitales: frecuencia cardiaca 130 lpm, frecuencia respiratoria 27 rpm, presión arterial 115/73 mmHg, temperatura 36.4ºC, con disnea, uso de músculos accesorios, taquicardia, taquipnea, con saturación a aire ambiente de 89%, como antecedentes de importancia destacaron toxicomanías positivas; se integraron datos clínicos de neumonía adquirida en la comunidad; la radiografía de tórax evidenció borramiento del ángulo costofrénico y costodiafragmático por lo que se sospechó derrame pleural; sin embargo, se decidió realizar ultrasonido pulmonar para confirmar derrame pleural vs consolidación pulmonar, en el que se observaron datos compatibles con escaso derrame pleural y zona de consolidación pulmonar basal derecha; se dio tratamiento con doble esquema antibiótico. Con este artículo se demuestra que el ultrasonido pulmonar resulta ser una herramienta efectiva y confiable en el diagnóstico temprano de neumonía en el servicio de Urgencias, sin necesidad de realizar radiografía de tórax, incluso tiene sensibilidad mucho mayor para el diagnóstico de derrame pleural en comparación con la radiografía convencional.

Abstract This paper reports the clinical case of a 54-year-old male patient, which entered to the service due to respiratory difficulty. Patient initiated his current suffering a month before the hospital admission with productive cough with purulent, abundant expectoration, not quantified fever, and loss of weight, two days before to his hospital admission respiratory difficulty was added that was exacerbated approximately 3 hours prior to income. To the physical exploration conscious patient was observed with vital signs: HR 130 bpm, RR 27 bpm, blood pressure 115/73 mmHg, temperature 36.4ºC, with shortness of breath, use of accessory muscles, tachycardia, tachypnea, with saturation to air ambience of 89%; precedents of importance: positive drug dependency; clinic data were integrated of community-acquired pneumonia, X-ray chest evidenced effacement of the costophrenic and costodiaphragmatic angle; thus, it was suspected pleural effusion; however, it was decided to perform pulmonary USG to confirm effusion vs pleural pulmonary consolidation, in which there were data compatible with low pleural effusion and right basal pulmonary consolidation area; handling was started with double antibiotic scheme. This article demonstrates that pulmonary USG turns out to be an effective and reliable tool in the early diagnosis of pneumonia in the Emergency Department, without necessity of chest X-ray, it has even much larger sensitivity for diagnosis of pleural effusion in comparison with conventional radiography.