TY - JOUR
T1 - Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure
AU - Marini, Claudia
AU - Fragasso, Gabriele
AU - Italia, Leonardo
AU - Sisakian, Hamayak
AU - Tufaro, Vincenzo
AU - Ingallina, Giacomo
AU - Stella, Stefano
AU - Ancona, Francesco
AU - Loiacono, Ferdinando
AU - Innelli, Pasquale
AU - Costantino, Marco Fabio
AU - Sahakyan, Laura
AU - Gabrielyan, Sirvard
AU - Avetisyan, Mariam
AU - Margonato, Alberto
AU - Agricola, Eustachio
N1 - Publisher Copyright:
©
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - 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.
AB - 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.
KW - heart failure
KW - heart failure with reduced ejection fraction
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U2 - 10.1136/heartjnl-2019-316429
DO - 10.1136/heartjnl-2019-316429
M3 - Article
C2 - 32571960
AN - SCOPUS:85091133144
VL - 106
SP - 1934
EP - 1939
JO - Heart
JF - Heart
SN - 1355-6037
IS - 24
ER -