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Subclinical congestion assessed by lung ultrasound in ST segment elevation myocardial infarction
  1. José Carreras-Mora1,2,
  2. Clara Simón-Ramón3,
  3. María Vidal-Burdeus4,
  4. Laura Rodríguez-Sotelo3,
  5. Alessandro Sionis3,5,
  6. Teresa Giralt-Borrell1,2,
  7. Andrea Izquierdo-Marquisá1,
  8. Clara Rodríguez-González1,
  9. Núria Farré1,6,
  10. Miguel Cainzos-Achirica1,6,
  11. Helena Tizón-Marcos1,7,
  12. Joan Garcia-Picart3,
  13. Laia Milà-Pascual4,
  14. Beatriz Vaquerizo1,6,
  15. Mercedes Rivas-Lasarte7,8,
  16. Núria Ribas-Barquet1,6
  1. 1 Department of Cardiology, Hospital del Mar, Barcelona, Spain
  2. 2 Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
  3. 3 Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  4. 4 Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  5. 5 IIB-Sant Pau, Barcelona, Spain
  6. 6 Heart Diseases Biomedical Research Group, Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
  7. 7 CIBERCV, Madrid, Spain
  8. 8 Advanced Heart Failure and Cardiac Transplantation Unit, Puerta de Hierro University Hospital of Majadahonda, Madrid, Spain
  1. Correspondence to Dr José Carreras-Mora, Department of Cardiology, Hospital del Mar, Barcelona, 08003, Spain; jcarrerasmora{at}


Objective We evaluated the prognostic value of subclinical congestion assessed by lung ultrasound (LUS) in patients admitted for ST segment elevation myocardial infarction (STEMI).

Methods This was a multicentre study that prospectively enrolled 312 patients admitted for STEMI without signs of heart failure (HF) at admission. LUS was performed during the first 24 hours after revascularisation and classified patients as having either wet lung (three or more B-lines in at least one lung field) or dry lung. The primary endpoint was a composite of acute HF, cardiogenic shock or death during hospitalisation. The secondary endpoint was a composite of readmission for HF or new acute coronary syndrome or death during 30-day follow-up. Zwolle score was calculated in all patients to assess predictive improvement by adding the result of the LUS to this score.

Results 14 patients (31.1%) in the wet lung group presented the primary endpoint vs 7 (2.6%) in the dry lung group (adjusted RR 6.0, 95% CI 2.3 to 16.2, p=0.007). The secondary endpoint occurred in five patients (11.6%) in the wet lung group and in three (1.2%) in the dry lung group (adjusted HR 5.4, 95% CI 1.0 to 28.7, p=0.049). Addition of LUS improved the ability of the Zwolle score to predict the follow-up composite endpoint (net reclassification improvement 0.99). LUS showed a very high negative predictive value in predicting in-hospital and follow-up endpoints (97.4% and 98.9%, respectively).

Conclusion Early subclinical pulmonary congestion identified by LUS in patients with Killip I STEMI at hospital admission is associated with adverse outcomes during hospitalisation and 30-day follow-up.

  • Diagnostic Imaging
  • Acute Coronary Syndrome
  • Heart Failure, Systolic

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • MR-L and NR-B are joint senior authors.

  • Twitter @jose_carmora, @ClaraSimonR, @sionis_a, @m_rivaslasarte

  • Correction notice This article has been corrected since it was first published. The affiliations have been modified and it has been indicated that MR-L nd NR-B are joint senior authors.

  • Contributors Guarantor: JC-M. Study conception and design: JC-M, AS, MC-A, NF, BV, MR-L and NR-B. Data collection: JC-M, CS-R, MV-B, LR-S, TG-B, AI-M, CR-G, HT-M, JG-P, LM-P and NR-B. Analysis and interpretation of results: JC-M, NR-B, MC-A and MR-L. Draft manuscript preparation: JC-M, MR-L and NR-B. All authors reviewed the results and approved the final version of the manuscript.

  • Funding JC-M received Original Research Projects Grant from the Catalan Society of Cardiology and LR-S received Scholarship for Training and Research from the Association of Ischemic Heart Disease and Cardiological Critical Care of the Spanish Society of Cardiology.

  • Competing interests None declared.

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

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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