Systemic and pulmonary congestion by ultrasound and prognosis in heart failure: A pooled cohort analysis

We assessed the prognostic value of the relation between pulmonary and systemic congestion in HF.

Increasing congestion, either pulmonary (detected by ultrasound) or systemic (quantified by inferior vena cava (IVC) diameter), is associated with worse outcomes in patients with heart failure (HF).

We performed a pooled analysis on five European cohorts of patients with HF. The primary outcome was a composite of hospitalization for HF and all-cause death. Patients with mild pulmonary congestion (lowest tercile of B-lines, <16 for in-patients, <3 for out-patients) and un-dilated IVC (<21 mm) were considered as the reference group.

835 patients (mean age 75 ± 11 years, 60 % men, 60 % in-patients) were included. Compared to patients with the lowest degree of congestion (n = 124 in-patients, 25 %, and 75 out-patients, 22 %), those with greater congestion were older, had higher natriuretic peptides and lower tricuspid annular plane systolic excursion, but similar left ventricular ejection fraction (LVEF). Among in-patients, 163 (33 %) were re-hospitalized or died during a follow-up of 180 days while 125 (37 %) out-patients were re-hospitalized or died during a median follow-up of 600 days. In models adjusted for age and LVEF, out-patients with the greatest degree of isolated pulmonary congestion (highest tercile) were at higher risk than reference group (HR: 2.34 (1.11-4.91), p = 0.025). A dilated IVC was associated with a greater risk in both in-patients and out-patients when pulmonary congestion was more than mild.

Among patients with HF, the combination of both pulmonary and systemic congestion is associated with a worse prognosis than either sign of congestion alone.