Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure

Claudia Marini, Gabriele Fragasso, Leonardo Italia, Hamayak Sisakian, Vincenzo Tufaro, Giacomo Ingallina, Stefano Stella, Francesco Ancona, Ferdinando Loiacono, Pasquale Innelli, Marco Fabio Costantino, Laura Sahakyan, Sirvard Gabrielyan, Mariam Avetisyan, Alberto Margonato, Eustachio Agricola

Research output: Contribution to journalArticlepeer-review

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: â € PE+LUS' group undergoing PE and LUS and â € 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 â € PE+LUS' group undergoing PE and LUS, and in â € PE only' group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in â € PE+LUS' group (9.4% vs 21.4% in â € 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 â € PE+LUS' group, whereas in â € 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.

Original languageEnglish
Pages (from-to)1934-1939
Number of pages6
JournalHeart
Volume106
Issue number24
DOIs
Publication statusPublished - Dec 1 2020

Keywords

  • heart failure
  • heart failure with reduced ejection fraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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