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Published on: January 14, 2014
Imaging Congestion With a Pocket Ultrasound Device: Prognostic Implications in Patients With Chronic Heart Failure
Mikael Gustafsson1, Urban Alehagen1, Peter Johansson1
1Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
Insights
A handheld ultrasound device effectively identified pulmonary congestion in heart failure (HF) patients. These findings, including lung water and pleural effusion, significantly predicted adverse outcomes like hospitalization and death.
Area of Science:
- Cardiology
- Medical Imaging
- Critical Care Medicine
Background:
- Venous congestion is a prevalent complication in patients diagnosed with chronic heart failure (HF).
- Assessing the congestive status of HF patients is crucial for predicting prognosis.
- Pocket-sized imaging devices offer a potential tool for evaluating congestion.
Purpose of the Study:
- To evaluate the utility of a pocket-sized imaging device (PID) for assessing venous congestion in heart failure patients.
- To correlate ultrasound findings with patient prognosis.
Main Methods:
- One hundred four outpatients with HF were enrolled.
- Interstitial lung water (ILW) via B-lines (comet tail artifact - CTA), pleural effusion (PE), and inferior vena cava diameter (VCI) were assessed using a PID.
- Correlation with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and follow-up for hospitalizations and deaths were conducted.
Main Results:
- Twenty-eight patients had CTA, and 8 had PE; median VCI diameter was 18 mm.
- CTA and PE showed weak correlations with NT-proBNP.
- CTA and/or PE significantly increased the risk of death or hospitalization (hazard ratio 3-4).
Conclusions:
- Handheld ultrasound devices can effectively detect signs of pulmonary congestion.
- The presence of pulmonary congestion, particularly CTA, has a significant prognostic impact in stable heart failure patients.
- Ultrasound-derived congestion assessment aids in risk stratification for heart failure management.
Background:
Venous congestion is common in patients with chronic heart failure (HF). We used a pocket-sized ultrasound imaging device (PID) to assess the patients' congestive status and related our findings to prognosis.
Methods And Results:
One hundred four consecutive outpatients from an HF outpatient clinic were studied. Interstitial lung water (ILW), pleural effusion (PE), and the diameter of the inferior vena cava (VCI) were assessed with the use of a PID. ILW was assessed by demonstration of B-lines (comet tail artifact (CTA). Out of the 104 patients, 28 had CTA and 8 had PE. Median VCI diameter was 18 mm (interquartile range 14-22 mm). Each of these parameters correlated weakly (r = 0.26-0.37; P < .05) with the HF biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP). During the median follow-up time of 530 days, 18 hospitalizations and 14 deaths were registered. Findings of CTA, PE, or both increased the risk of death or hospitalization (hazard ratio 3-4; P < .05). After adjustment for age, cardiac systolic function, and NT-proBNP, this difference remained significant for CTA alone and CTA + PE combined, but not for PE alone.
Conclusions:
With the use of a handheld ultrasound device, signs of pulmonary congestion could be demonstrated. When found, these had a significant prognostic impact in clinically stable HF.
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