Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
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- dc.contributor.author Rivas-Lasarte, Mercedes
- dc.contributor.author Maestro, Alba
- dc.contributor.author Fernández-Martínez, Juan
- dc.contributor.author López-López, Laura
- dc.contributor.author Solé-González, Eduard
- dc.contributor.author Vives-Borras, Miquel
- dc.contributor.author Vives-Borras, Miquel
- dc.contributor.author Montero, Santiago
- dc.contributor.author Mesado, Nuria
- dc.contributor.author Pirla, María J.
- dc.contributor.author Mirabet, Sonia
- dc.contributor.author Fluvià Brugues, Paula
- dc.contributor.author Brossa, Vicens
- dc.contributor.author Sionis, Alessandro
- dc.contributor.author Roig, Eulàlia
- dc.contributor.author Cinca, Juan
- dc.contributor.author Álvarez-García, Jesus
- dc.date.accessioned 2020-10-26T08:04:15Z
- dc.date.available 2020-10-26T08:04:15Z
- dc.date.issued 2020
- dc.description.abstract Aims: Residual pulmonary congestion at hospital discharge can worsen the outcomes in patients with heart failure (HF) and can be detected by lung ultrasound (LUS). The aim of this study was to analyse the prevalence of subclinical pulmonary congestion at discharge and its impact on prognosis in patients admitted for acute HF. Methods and results: This is a post-hoc analysis of the LUS-HF trial. LUS was performed by the investigators in eight chest zones with a pocket device. Physical exam was subsequently performed by the treating physicians. Primary outcome was a combined endpoint of rehospitalization, unexpected visit for HF worsening or death at 6- month follow-up. Subclinical pulmonary congestion at discharge was defined as the presence of ≥5 B-lines in LUS in absence of rales in the auscultation employing the area under the ROC curve. At discharge, 100 patients (81%) did not show clinical signs of pulmonary congestion. Of these, 41 had ≥5 B-lines. Independent factors related with the presence of subclinical pulmonary congestion were anaemia, higher New York Heart Association (NYHA) class, and N terminal pro brain natriuretic peptide (NT-proBNP). After adjusting by propensity score analysis including age, renal insufficiency, atrial fibrillation, NYHA class, NT-proBNP levels, clinical congestion, and the trial intervention, the presence of subclinical pulmonary congestion at discharge was a risk factor for the occurrence of the primary outcome (hazard ratio 2.63; 95% confidence interval: 1.08-6.41; P = 0.033). Conclusions: Up to 40% of patients considered 'dry' according to pulmonary auscultation presents subclinical congestion at hospital discharge that can be detected by LUS and implies a worse prognosis at 6- month follow-up. Comorbidities, high values of natriuretic peptides, and higher NYHA class are the factors related with its presence.
- dc.format.mimetype application/pdf
- dc.identifier.citation Rivas-Lasarte M, Maestro A, Fernández-Martínez J, López-López L, Solé-González E. et al. Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure. ESC Heart Fail. 2020 Jul 7;7(5):2621–8. DOI: 10.1002/ehf2.12842
- dc.identifier.doi http://dx.doi.org/10.1002/ehf2.12842
- dc.identifier.issn 2055-5822
- dc.identifier.uri http://hdl.handle.net/10230/45570
- dc.language.iso eng
- dc.publisher Wiley
- dc.rights Copyright © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
- dc.subject.keyword Heart failure
- dc.subject.keyword Lung ultrasound
- dc.subject.keyword Prognosis
- dc.subject.keyword Pulmonary congestion
- dc.title Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion