Rationale and design of a prospective study evaluating the prognostic value of lung ultrasound in patients with heart...

Lung ultrasound (LUS) could detect subclinical congestion and identify patients at increased risk of events. The role of LUS in chronic heart failure (HF) has been widely studied in HF clinics, but little is known about its usefulness in the community. We will assess the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients managed in primary care (PC).

We will conduct a prospective study with 192 patients at 17 PC centers of the metropolitan area of Barcelona. We will include patients with HF and left ventricular ejection fraction (LVEF) ≥ 50%, with a previous hospital admission for HF decompensation and stable NYHA (New York Heart Association) functional class in the last 3 months. At baseline visit, we will collect demographic and clinical data, and the following issues will be performed: (a) a blood tests, including cardiac biomarkers; (b) a six-minute walking test; (c) a lung ultrasound; (d) a quality of life test Minnesota Living with Heart Failure Test), and (e) frailty tests (Gerontopole and Frailty Index based on the Comprehensive Geriatric Assessment (VGI-index)). LUS will be performed in semisupine position using a 28-area protocol, with a hand-held probe. Follow-up will be carried out every 6 months for 2 years by reviewing medical records and telephone calls. All the events, including HF hospitalizations, cardiovascular death, all-cause death, and visits to PCs and hospital emergencies due to HF will be recorded. After two years another in-office visit will be performed, and all the tests performed at the baseline visit will be repeated.

The use of LUS in PC centers could improve the monitoring and management of patients with HF by identifying those at higher risk of hospital admission and death.