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Prevalence, pattern and clinical relevance of ultrasound indices of congestion in outpatients with heart failure
Author(s) -
Pellicori Pierpaolo,
Shah Parin,
Cuthbert Joe,
Urbinati Alessia,
Zhang Jufen,
KallvikbackaBennett Anna,
Clark Andrew L.,
Cleland John G.F.
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1383
Subject(s) - medicine , heart failure , interquartile range , cardiology , inferior vena cava , pulmonary artery , clinical significance , ultrasound , radiology
Aims Even if treatment controls symptoms, patients with heart failure may still be congested. We aimed at assessing the prevalence and clinical relevance of congestion in outpatients with chronic heart failure. Methods and results We recorded clinical and ultrasound [lung B‐lines; inferior vena cava (IVC) diameter; internal jugular vein diameter before and after a Valsalva manoeuvre (JVD ratio)] features of congestion in heart failure patients during a routine check‐up. Of 342 patients who attended, predominantly in New York Heart Association class I or II ( n = 257; 75%), 242 (71%) had at least one feature of congestion, either clinical ( n = 139; 41%) or by ultrasound ( n = 199; 58%). Amongst patients ( n = 203, 59%) clinically free of congestion, 31 (15%) had ≥ 14 B‐lines, 57 (29%) had a dilated IVC (> 2.0 cm), 38 (20%) had an abnormal JVD ratio (< 4), 87 (43%) had at least one of these, and 27 (13%) had two or more. During a median follow‐up of 234 (interquartile range 136–351) days, 60 patients (18%) died or were hospitalized for heart failure. In univariable analysis, each clinical and ultrasound measure of congestion was associated with increased risk but, in multivariable models, only higher N‐terminal pro‐B‐type natriuretic peptide and IVC, and lower JVD ratio, were associated with the composite outcome. Conclusions Many patients with chronic heart failure with few symptoms have objective evidence of congestion and this is associated with an adverse prognosis. Whether using these measures of congestion to guide management improves outcomes requires investigation.