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Heart failure and cardiomyopathies
Original research
Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure
  1. Claudia Marini1,
  2. Gabriele Fragasso2,
  3. Leonardo Italia1,
  4. Hamayak Sisakian3,
  5. Vincenzo Tufaro1,
  6. Giacomo Ingallina1,
  7. Stefano Stella1,
  8. Francesco Ancona1,
  9. Ferdinando Loiacono2,
  10. Pasquale Innelli4,
  11. Marco Fabio Costantino4,
  12. Laura Sahakyan3,
  13. Sirvard Gabrielyan3,
  14. Mariam Avetisyan3,
  15. Alberto Margonato2,5,
  16. Eustachio Agricola1,5
  1. 1 Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
  2. 2 Heart Failure Clinic, Clinical Cardiology, San Raffaele Scientific Institute, Milan, Italy
  3. 3 Department of Cardiology, Yerevan State Medical University, University Hospital 1, Yerevan, Armenia
  4. 4 SSD Imaging Cardiovascular Department, San Carlo Hospital, Potenza, Italy
  5. 5 Vita-Salute San Raffaele University, Milan, Italy
  1. Correspondence to Dr Claudia Marini, San Raffaele Hospital, Milano 20132, Italy; claudia.marini{at}outlook.com

Abstract

Objective Pulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF.

Methods In this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: ‘PE+LUS’ group undergoing PE and LUS and ‘PE only’ group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up.

Results A total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in ‘PE+LUS’ group undergoing PE and LUS, and in ‘PE only’ group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in ‘PE+LUS’ group (9.4% vs 21.4% in ‘PE only’ group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in ‘PE+LUS’ group, whereas in ‘PE only’ group both were increased. There were no differences in mortality between the two groups.

Conclusions LUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF.

  • heart failure
  • heart failure with reduced ejection fraction

https://doi.org/10.1136/heartjnl-2019-316429

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    Footnotes

    • Contributors EA, GF, AM: study planning, study analysis and responsible for the overall content as guarantors. CM, GF, LI, HS, VT, GI, SS, FA, FL, PI, MFC, LS, SG, MA, AM, EA conducted the study and performed the examinations. EA, CM, LI performed the statistical analysis and wrote the manuscript. All authors have read and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article and uploaded as supplementary information, and further data are available on request.