Utility of lung ultrasound to identify patients at risk of rehospitalization for acute decompensated heart failure

Abstract

Introduction

Residual congestion at hospital discharge predicts adverse outcomes in acute decompensated heart failure (ADHF). Lung ultrasound (LUS) is a reliable tool for assessing pulmonary congestion. This study aims to evaluate a simplified 4-zone LUS method for identifying heart failure patients at risk after discharge.

Methods

This prospective study included adults hospitalized for ADHF without treatable secondary causes. We employed a 4-zone LUS method to quantify B-lines. The primary endpoint was a composite of mortality or rehospitalization within 180 days. We used univariate and multivariate Cox models to evaluate the prognostic value of B-lines. A receiver operating characteristic (ROC) curve identified the optimal B-lines threshold.

Results

We included 155 patients (median age: 81 years [IQR 75–85]; 52.9 % male). After the follow-up period, 53 (34.2 %) patients met the primary endpoint. The ROC curve for the number of B-lines at discharge showed an AUC of 0.8, with 7 B-lines identified as the optimal cutoff (sensitivity: 70 %, specificity: 82 %). In univariate analysis, the global B-line count at discharge (HR: 1.33, 95 % CI 1.22-1.45) was significantly associated with the primary endpoint. Using a cutoff of ≥7 B-lines, the association was stronger (HR: 6.92, 95 % CI 3.80-12.60). After multivariable adjustment, ≥7 B-lines at discharge remained significant (HR: 4.41, 95 % CI 1.98-9.81).

Conclusion

In our population, the detection of 7 or more B-lines at discharge serves as a reliable marker for identifying patients at risk of mortality or rehospitalization within 180 days.