Abstract：
OBJECTIVE: Lung ultrasound (LUS) is often used to assess congestion in heart failure (HF). In this study, we assessed the prognostic role of LUS in patients with HF at admission and hospital discharge, and in an outpatient setting, and explored whether clinical factors [age, sex, left ventricular ejection fraction (LVEF), and atrial fibrillation] impact the prognostic value of LUS findings. Further, we assessed the incremental prognostic value of LUS on top of the following two clinical risk scores: (i) the atrial fibrillation, haemoglobin, elderly, abnormal renal parameters, diabetes mellitus (AHEAD) and (ii) the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) clinical risk scores.
RESULTS: We pooled data on patients hospitalized for HF or followed up in outpatient clinics from international cohorts. We enrolled 1947 patients at admission (n = 578), discharge (n = 389), and in outpatient clinics (n = 980). The total LUS B-line count was calculated for the eight-zone scanning protocol. The primary outcome was a composite of rehospitalization for HF and all-cause death. Compared with those in the lower tertiles of B lines, patients in the highest tertiles were older, more likely to have signs of HF and had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels. A higher number of B lines was associated with increased risk of primary outcome at discharge [Tertile 3 vs. Tertile 1: adjusted hazard ratio (HR): 5.74 (3.26-10.12), P < 0.0001] and in outpatients [Tertile 3 vs. Tertile 1: adjusted HR: 2.66 (1.08-6.54), P = 0.033]. Age and LVEF did not influence the prognostic capacity of LUS in different clinical settings. Adding B-line count to the MAGGIC and AHEAD scores improved net reclassification significantly in all three clinical settings.
CONCLUSIONS: A higher number of B lines in patients with HF was associated with an increased risk of morbidity and mortality, regardless of the clinical setting.
RESULTS: We pooled data on patients hospitalized for HF or followed up in outpatient clinics from international cohorts. We enrolled 1947 patients at admission (n = 578), discharge (n = 389), and in outpatient clinics (n = 980). The total LUS B-line count was calculated for the eight-zone scanning protocol. The primary outcome was a composite of rehospitalization for HF and all-cause death. Compared with those in the lower tertiles of B lines, patients in the highest tertiles were older, more likely to have signs of HF and had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels. A higher number of B lines was associated with increased risk of primary outcome at discharge [Tertile 3 vs. Tertile 1: adjusted hazard ratio (HR): 5.74 (3.26-10.12), P < 0.0001] and in outpatients [Tertile 3 vs. Tertile 1: adjusted HR: 2.66 (1.08-6.54), P = 0.033]. Age and LVEF did not influence the prognostic capacity of LUS in different clinical settings. Adding B-line count to the MAGGIC and AHEAD scores improved net reclassification significantly in all three clinical settings.
CONCLUSIONS: A higher number of B lines in patients with HF was associated with an increased risk of morbidity and mortality, regardless of the clinical setting.
摘要：
背景：肺部超声（LUS）通常用于评估心力衰竭（HF）中的充血。在这项研究中,我们评估了LUS在HF患者入院和出院时的预后作用,并在门诊病人环境中探索临床因素(年龄，性别,左心室射血分数（LVEF）和心房颤动）影响LUS结果的预后价值。Further,我们在AHEAD和MAGGIC临床风险评分基础上评估了LUS的增量预后价值.
结果：我们汇集了国际队列中HF住院患者或门诊随访患者的数据。我们招募了1,947名患者，在入学时（n=578），出院（n=389）和门诊（n=980）。计算8区扫描方案的总LUSB线计数。主要结局是心力衰竭再住院和全因死亡的复合结果。与B线较低的三分位数相比，最高三分位数的患者年龄较大，更有可能有HF的迹象和更高的NT-proBNP水平。B线数量增加与出院时主要结局风险增加相关(Tertile3vsTertile1:adjustedHR=5.74(3.26-10.12),p<0.0001）和门诊患者（Tertile3vsTertile1：adjustedHR=2.66（1.08-6.54），p=0.033)。年龄和LVEF不影响LUS在不同临床情况下的预后能力。在所有三种临床设置中，将B线计数添加到MAGGIC和AHEAD评分显着改善了净重新分类。
结论：HF患者的B线数量增加与发病率和死亡率风险增加相关，无论临床环境如何。
结果：我们汇集了国际队列中HF住院患者或门诊随访患者的数据。我们招募了1,947名患者，在入学时（n=578），出院（n=389）和门诊（n=980）。计算8区扫描方案的总LUSB线计数。主要结局是心力衰竭再住院和全因死亡的复合结果。与B线较低的三分位数相比，最高三分位数的患者年龄较大，更有可能有HF的迹象和更高的NT-proBNP水平。B线数量增加与出院时主要结局风险增加相关(Tertile3vsTertile1:adjustedHR=5.74(3.26-10.12),p<0.0001）和门诊患者（Tertile3vsTertile1：adjustedHR=2.66（1.08-6.54），p=0.033)。年龄和LVEF不影响LUS在不同临床情况下的预后能力。在所有三种临床设置中，将B线计数添加到MAGGIC和AHEAD评分显着改善了净重新分类。
结论：HF患者的B线数量增加与发病率和死亡率风险增加相关，无论临床环境如何。
