Author + information
- Received May 8, 2013
- Revision received August 19, 2013
- Accepted August 19, 2013
- Published online November 1, 2013.
- Marcelo Haertel Miglioranza, MD, MHSc∗∗ (, )
- Luna Gargani, MD†,
- Roberto Tofani Sant'Anna, MD∗,
- Marciane Maria Rover, MD∗,
- Vitor Magnus Martins, MD∗,
- Augusto Mantovani, MD∗,
- Cristina Weber, RN∗,
- Maria Antonieta Moraes, RN, PhD∗,
- Carlos Jader Feldman, MD∗,
- Renato Abdala Karam Kalil, MD, PhD∗,‡,
- Rosa Sicari, MD, PhD†,
- Eugenio Picano, MD, PhD† and
- Tiago Luiz Luz Leiria, MD, PhD∗
- ∗Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil
- †Institute of Clinical Physiology, National Council of Research, Pisa, Italy
- ‡Federal Health Sciences University of Porto Alegre, Porto Alegre, Brazil
- ↵∗Reprint requests and correspondence:
Dr. Marcelo Haertel Miglioranza, Unidade de Pesquisa, Instituto de Cardiologia do Rio Grande do Sul, Av. Princesa Isabel, 370, Porto Alegre/RS, CEP 90620-000, Brazil.
Objectives The aim of this study was to define the performance of lung ultrasound (LUS) compared with clinical assessment, natriuretic peptides, and echocardiography, to evaluate decompensation in patients with systolic heart failure (HF) in an outpatient clinic.
Background Evaluation of pulmonary congestion in chronic HF is challenging. LUS has been recently proposed as a reliable tool for the semiquantification of extravascular lung water through assessment of B-lines.
Methods This was a cohort study of patients with moderate to severe systolic HF. Receiver-operating characteristic (ROC) analyses were performed to compare LUS with a previously validated clinical congestion score (CCS), amino-terminal portion of B-type natriuretic peptide (NT-proBNP), E/e′ ratio, chest x-ray, and 6-min walk test.
Results Ninety-seven patients were enrolled. Decompensation was present in 57.7% of patients when estimated by CCS, 68% by LUS, 53.6% by NT-proBNP, and 65.3% by E/e′ ≥15. The number of B-lines was correlated to NT-proBNP (r = 0.72; p < 0.0001), E/e′ (r = 0.68; p < 0.0001), and CCS (r = 0.43; p < 0.0001). In ROC analyses, considering as reference for decompensation a combined method (E/e′ ≥15 and/or NT-proBNP >1,000 pg/ml), LUS yielded a C-statistic of 0.89 (95% confidence interval: 0.82 to 0.96), providing the best accuracy with a cutoff ≥15 B-lines (sensitivity 85%, specificity 83%). A systematic approach using CCS, E/e′, NT-proBNP, chest x-ray, and 6-min walk test in different combinations as reference for decompensation also corroborated this cutoff and found a similar accuracy for LUS.
Conclusions In an HF outpatient clinic, B-lines were significantly correlated with more established parameters of decompensation. A B-line ≥15 cutoff could be considered for a quick and reliable assessment of decompensation in outpatients with HF.
Dr. Miglioranza received a post-graduate grant from CAPES, a Brazilian governmental agency for post-graduate support. Dr. Kalil received a research grant from CNPq, a Brazilian governmental agency for research support. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 8, 2013.
- Revision received August 19, 2013.
- Accepted August 19, 2013.
- American College of Cardiology Foundation