B-Lines by Lung Ultrasound Can Predict Worsening Heart Failure in Acute Myocardial Infarction During Hospitalization and Short-Term Follow-Up

Frontiers in Cardiovascular Medicine

article

Jiexin He¹  Shixin Yi¹  Yingling Zhou¹  Xiangming Hu¹  Ziheng Lun¹  Haojian Dong¹  Ying Zhang¹ 

[1]Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences

关键词: lung ultrasound;    acute myocardial infarction;    B-lines;    pulmonary edema;    heart failure;   

DOI  :  10.3389/fcvm.2022.895133

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Acute myocardial infarction (AMI) with pulmonary edema shows a worse prognosis. Lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. It has been proved to predict prognosis in heart failure; however, whether it can be used as a short-term prognostic marker in AMI and provide incremental value to Killip classification is unknown. Methods We performed echocardiography and LUS by the 8-zone method in patients enrolled in Guangdong Provincial People's Hospital undergoing percutaneous coronary intervention for AMI from March to July 2021. The lung water detected by LUS was defined as B-lines, and the sum of the B-line number from 8 chest zones was calculated. Besides, the classification into LUS according to the pulmonary edema severity was as follows: normal (B-line numbers <5), mild (B-line numbers ≥5 and <15), moderate (B-line numbers ≥15 and <30), and severe (B-line numbers ≥30). The NT-proBNP analysis was performed on the same day. All patients were followed up for 30 days after discharge. The adverse events were defined as all-cause death, worsening heart failure in hospitalization, or re-hospitalization for heart failure during the follow-up. Results Sixty three patients were enrolled consecutively and followed up for 30 days. The number of B-lines at admission (median 7[3–15]) was correlated with NT-proBNP ( r = 0.37, p = 0.003) and negatively correlated with ejection fraction ( r = −0.43; p < 0.001) separately. In the multivariate analysis, B-line number was an independent predictor of short-term outcomes in AMI patients (in-hospital, adjusted OR 1.13 [95% CI: 1.04–1.23], P = 0.006; 30-day follow-up, adjusted OR 1.09 [95% CI: 1.01–1.18], P = 0.020). For in-hospital results, the area under the receiver operating characteristic curves (AUCs) were 0.639 ( P = 0.093), 0.837 ( P < 0.001), and 0.847 ( P < 0.001) for Killip, LUS and their combination, respectively. For the diagnosis of 30-day adverse events, the AUCs were 0.665 for the Killip classification ( P = 0.061), 0.728 for LUS ( P = 0.010), and 0.778 for their combination ( P = 0.002). Conclusion B-lines by lung ultrasound can be an independent predictor of worsening heart failure in AMI during hospitalization and short-term follow-up and provides significant incremental prognostic value to Killip classification.

【 授权许可】

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