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Panisello-Tafalla A, Haro-Montoya M, Caballol-Angelats R, Montelongo-Sol M, Rodriguez-Carralero Y, Lucas-Noll J, Clua-Espuny JL. Prognostic Significance of Lung Ultrasound for Heart Failure Patient Management in Primary Care: A Systematic Review. J Clin Med 2024; 13:2460. [PMID: 38730988 PMCID: PMC11084515 DOI: 10.3390/jcm13092460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Heart failure (HF) affects around 60 million individuals worldwide. The primary aim of this study was to evaluate the efficacy of lung ultrasound (LUS) in managing HF with the goal of reducing hospital readmission rates. Methods: A systematic search was conducted on PubMed, Embase, Google Scholar, Web of Science, and Scopus, covering clinical trials, meta-analyses, systematic reviews, and original articles published between 1 January 2019 and 31 December 2023, focusing on LUS for HF assessment in out-patient settings. There is a potential for bias as the effectiveness of interventions may vary depending on the individuals administering them. Results: The PRISMA method synthesized the findings. Out of 873 articles identified, 33 were selected: 19 articles focused on prognostic assessment of HF, 11 centred on multimodal diagnostic assessments, and two addressed therapeutic guidance for HF diagnosis. LUS demonstrates advantages in detecting subclinical congestion, which holds prognostic significance for readmission and mortality during out-patient follow-up post-hospital-discharge, especially in complex scenarios, but there is a lack of standardization. Conclusions: there are considerable uncertainties in their interpretation and monitoring changes. The need for an updated international consensus on the use of LUS seems obvious.
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Affiliation(s)
- Anna Panisello-Tafalla
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Primary Care Health Tortosa-est, 43500 Tortosa, Spain
- Programa Doctorado Biomedicines, University Rovira-Virgili, Campus Terres de l’Ebre, 43500 Tortosa, Spain
| | - Marcos Haro-Montoya
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Unitat Docent Terres de l’Ebre-Tortosa, Primary Health Care Tortosa-est, 43500 Tortosa, Spain; (M.H.-M.); (M.M.-S.); (Y.R.-C.)
| | - Rosa Caballol-Angelats
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Family and Community Medicine Unit in Primary Care Health Tortosa-est, 43500 Tortosa, Spain;
| | - Maylin Montelongo-Sol
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Unitat Docent Terres de l’Ebre-Tortosa, Primary Health Care Tortosa-est, 43500 Tortosa, Spain; (M.H.-M.); (M.M.-S.); (Y.R.-C.)
| | - Yoenia Rodriguez-Carralero
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Unitat Docent Terres de l’Ebre-Tortosa, Primary Health Care Tortosa-est, 43500 Tortosa, Spain; (M.H.-M.); (M.M.-S.); (Y.R.-C.)
| | | | - Josep Lluis Clua-Espuny
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Primary Care Health Tortosa-est, 43500 Tortosa, Spain
- Programa Doctorado Biomedicines, University Rovira-Virgili, Campus Terres de l’Ebre, 43500 Tortosa, Spain
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Family and Community Medicine Unit in Primary Care Health Tortosa-est, 43500 Tortosa, Spain;
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), SAP Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
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Dimitriadis K, Damianaki A, Bletsa E, Pyrpyris N, Tsioufis P, Theofilis P, Beneki E, Tatakis F, Kasiakogias A, Oikonomou E, Petras D, Siasos G, Aggeli K, Tsioufis K. Renal Congestion in Heart Failure: Insights in Novel Diagnostic Modalities. Cardiol Rev 2024:00045415-990000000-00224. [PMID: 38427026 DOI: 10.1097/crd.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Heart failure is increasingly prevalent and is estimated to increase its burden in the following years. A well-reported comorbidity of heart failure is renal dysfunction, where predominantly changes in the patient's volume status, tubular necrosis or other mechanical and neurohormonal mechanisms seem to drive this impairment. Currently, there are established biomarkers evaluating the patient's clinical status solely regarding the cardiovascular or renal system. However, as the coexistence of heart and renal failure is common and related to increased mortality and hospitalization for heart failure, it is of major importance to establish novel diagnostic techniques, which could identify patients with or at risk for cardiorenal syndrome and assist in selecting the appropriate management for these patients. Such techniques include biomarkers and imaging. In regards to biomarkers, several peptides and miRNAs indicative of renal or tubular dysfunction seem to properly identify patients with cardiorenal syndrome early on in the course of the disease, while changes in their serum levels can also be helpful in identifying response to diuretic treatment. Current and novel imaging techniques can also identify heart failure patients with early renal insufficiency and assess the volume status and the effect of treatment of each patient. Furthermore, by assessing the renal morphology, these techniques could also help identify those at risk of kidney impairment. This review aims to present all relevant clinical and trial data available in order to provide an up-to-date summary of the modalities available to properly assess cardiorenal syndrome.
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Affiliation(s)
- Kyriakos Dimitriadis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | | | - Evanthia Bletsa
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | - Nikolaos Pyrpyris
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Theofilis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Eirini Beneki
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Fotis Tatakis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandros Kasiakogias
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | | | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | - Konstantina Aggeli
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Kaptein EM, Kaptein MJ. Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update. Clin Kidney J 2023; 16:1861-1877. [PMID: 37915939 PMCID: PMC10616489 DOI: 10.1093/ckj/sfad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 11/03/2023] Open
Abstract
Goals of volume management are to accurately assess intravascular and extravascular volume and predict response to volume administration, vasopressor support or volume removal. Data are reviewed that support the following: (i) Dynamic parameters reliably guide volume administration and may improve clinical outcomes compared with static parameters, but some are invasive or only validated with mechanical ventilation without spontaneous breathing. (ii) Ultrasound visualization of inferior vena cava (IVC) diameter variations with respiration reliably assesses intravascular volume and predicts volume responsiveness. (iii) Although physiology of IVC respiratory variations differs with mechanical ventilation and spontaneous breathing, the IVC collapsibility index (CI) and distensibility index are interconvertible. (iv) Prediction of volume responsiveness by IVC CI is comparable for mechanical ventilation and spontaneous breathing patients. (v) Respiratory variations of subclavian/proximal axillary and internal jugular veins by ultrasound are alternative sites, with comparable reliability. (vi) Data support clinical applicability of IVC CI to predict hypotension with anesthesia, guide ultrafiltration goals, predict dry weight, predict intra-dialytic hypotension and assess acute decompensated heart failure. (vii) IVC ultrasound may complement ultrasound of heart and lungs, and abdominal organs for venous congestion, for assessing and managing volume overload and deresuscitation, renal failure and shock. (viii) IVC ultrasound has limitations including inadequate visualization. Ultrasound data should always be interpreted in clinical context. Additional studies are required to further assess and validate the role of bedside ultrasonography in clinical care.
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Affiliation(s)
- Elaine M Kaptein
- Departments of Medicine, Divisions of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - Matthew J Kaptein
- Departments of Medicine, Divisions of Nephrology, University of Southern California, Los Angeles, CA, USA
- Loma Linda University Medical Center, Loma Linda, CA, USA
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Xu P, Ye L, Li L, Huang W, Liu W, Huang K. Comparison of the prognostic value, feasibility, and reproducibility among different scoring methods of 8‑point lung ultrasonography in patients with acute heart failure. Intern Emerg Med 2023; 18:2321-2332. [PMID: 37747589 DOI: 10.1007/s11739-023-03433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
There is no strong evidence that one of the B-line quantification approaches is clinically superior to the others, as the use of lung ultrasound (LUS) protocol becomes more commonplace in the treatment of heart failure (HF). This study, thus, aimed to evaluate to the prognostic value, feasibility, and reproducibility for selecting optimal B-line quantification methods. We enrolled patients with HF admitted to the emergency intensive care unit (EICU) in a single-center, prospective, observational study. LUS were performed before EICU discharge, and six B-line quantification methods were used to calculate scores. A total of 71 patients were enrolled. There was a moderately good discriminative value between six quantification methods and the composite outcome. The calibration curve of six B-line quantification methods for the probability of the composite outcome showed good agreement between prediction and observation. Decision curve presented that six B-line quantification methods presented similar net benefits at the entire range of threshold probabilities. Image interpretation time of Quantitative methods 1 and 2 was significantly less than that of other methods. Intraclass correlation coefficients (ICC) for B-pattern scoring systems (Quantitative methods 1 and 2) between two experts demonstrated the excellent level of clinical significance. Despite the similar discrimination, calibration and clinical usefulness, pattern-B scoring systems have the benefit of the feasibility and reproducibility over other methods.
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Affiliation(s)
- Ping Xu
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China.
- Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, Zigong, China.
| | - Li Ye
- Emergency Department, Fushun People's Hospital, Fushun, Sichuan, China
| | - Liang Li
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China
| | - Wenbin Huang
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China
| | - Wei Liu
- Emergency Department, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China
- Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, Zigong, China
| | - Kui Huang
- Department of Health Management Center, Zigong Fourth People's Hospital, Zigong, China
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Torres-Macho J, Cerqueiro-González JM, Arévalo-Lorido JC, Llácer-Iborra P, Cepeda-Rodrigo JM, Cubo-Romano P, Casas-Rojo JM, Ruiz-Ortega R, Manzano-Espinosa L, Lorenzo-Villalba N, Méndez-Bailón M. The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial. J Clin Med 2022; 11:jcm11164930. [PMID: 36013168 PMCID: PMC9409707 DOI: 10.3390/jcm11164930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound is highly sensitive for detecting PC. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF. Methods: A randomized, multicenter, single-blind clinical trial in patients discharged after hospitalization for decompensated HF. Participants were assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus standard of care (SOC). The primary endpoint was the combination of cardiovascular death, readmission, or emergency department or day hospital visit due to worsening HF at 6 months. In September 2020, after an interim analysis, patient recruitment was stopped. Results: A total of 79 patients were randomized (mean age 81.2 +/− 9 years) and 41 patients (51.8%) showed a left ventricular ejection fraction >50%. The primary endpoint occurred in 11 patients (29.7%) in the SOC group and in 11 patients (26.1%) in the LUS group (log-rank = 0.83). Regarding nonserious adverse events, no significant differences were found. Conclusions: LUS-guided diuretic therapy after hospital discharge due to ADHF did not show any benefit in survival or a need for intravenous diuretics compared with SOC.
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Affiliation(s)
- Juan Torres-Macho
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
- Correspondence:
| | | | | | - Pau Llácer-Iborra
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | | | - Pilar Cubo-Romano
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain
| | - Jose Manuel Casas-Rojo
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain
| | - Raúl Ruiz-Ortega
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Luis Manzano-Espinosa
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
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