Prognostic role of ultrasound diagnostic methods in patients with acute decompensated heart failure

Zhanna D. Kobalava, Department of Internal Diseases with Courses of Cardiology and Functional Diagnostics, Peoples' Friendship University of Russia, Moscow, Russia.
Tolkacheva Veronika Vladimirovna, Department of Internal Diseases with Courses of Cardiology and Functional Diagnostics, Peoples' Friendship University of Russia, Moscow, Russia.
Sarlykov Bekbolot Kanatbekovich, Department of Therapeutic Disciplines, Salymbekov Medical University, Bishkek, Kyrgyzstan.
Rena Sh Aslanova, Department of Internal Diseases with Courses of Cardiology and Functional Diagnostics, Peoples' Friendship University of Russia, Moscow, Russia.
Lapshin Artem Alekseevich, Department of Internal Diseases with Courses of Cardiology and Functional Diagnostics, Peoples' Friendship University of Russia, Moscow, Russia.
Nazarov Ivan Sergeevich, Department of Internal Diseases with Courses of Cardiology and Functional Diagnostics, Peoples' Friendship University of Russia, Moscow, Russia.
Smirnov Ilya Pavlovich, Department of Internal Diseases with Courses of Cardiology and Functional Diagnostics, Peoples' Friendship University of Russia, Moscow, Russia.
Maria V. Vatsik-Gorodetskaya, Department of Anesthesiology and Rehabilitation, Vinogradov City Clinical Hospital, Moscow, Russia.
Ghazaal Alavi Tabatabaei, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Ibrahim Al Zakwani, Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
Mohammed Al Jarallah, Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City, Kuwait.
Georgiana Luisa Baca, Department of Intramural Research Program, Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, USA.
Peter A. Brady, Advocate Health - MidwestFollow
Rajesh Rajan, Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City, Kuwait.
Bhavesh Talera, Department of Internal Medicine, Ivy Superspecialty Hospital, Chandigarh, India.

Affiliations

Illinois Masonic Medical Center

Abstract

Objectives:To evaluate the prognostic value (total mortality + repeated hospitalization for heart failure (HF)) of ultrasound diagnostic methods in patients with acute decompensated HF (ADHF).

Methods:The subjects were patients with chronic HF, who were hospitalized for ADHF. Using ultrasound methods-lung ultrasound, ultrasound assessment of hepatic venous congestion as per the venous excess ultrasound (VExUS) protocol, and indirect elastometry-we assessed the number of B-lines, hepatic venous congestion, and liver density of the patients. Clinical outcomes were assessed using a structured telephone survey method at 1, 3, 6, and 12 months after discharge. Combined overall mortality and readmission rates associated with HF were assessed. Threshold values for different methods for detecting congestion were set as follows: the number of B-lines in ultrasound data > 5; liver density > 6.2 kPa.

Results:The subjects were 207 patients (54.1% male; mean age = 70.7 ± 12.8 years). A total of 63 (30.4%) endpoints and 23 (11.1%) deaths were detected within 364 days (IQR = 197-365). Liver density > 6.2 kPa had a hazard ratio (HR) of 1.9 (95% CI: 1.0-3.3; p = 0.029). Hepatic venous congestion (VExUS protocol) had HR of 2.8 (95% CI: 1.3-5.7; p = 0.004). There was a significant increase in the risk of overall prognostic value in the presence of congestion, identified by liver fibroelastometry + lung ultrasound (HR = 10.5, 95% CI: 2.3-46.2; p = 0.002). The ultrasound assessment of hepatic venous congestion (VExUS + lung ultrasound protocol) yielded HR of 16.7 (95% CI: 3.9-70.7; p < 0.001). For all three methods combined, the overall HR was 40.1 (95% CI: 6.6-243.1; p < 0.001).

Conclusions:A combination of ultrasound diagnostic methods that include the number of B-lines, presence of hepatic venous congestion according to the VExUS protocol, and liver density according to indirect elastometry at discharge may have an independent prognostic value for patients with ADHF.

Type

Article

PubMed ID

39430621

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