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Prognostic Value of Dynamic Changes in Pulmonary Congestion During Exercise Stress Echocardiography in Heart Failure With Preserved Ejection Fraction

Abstract : Background: Patients with heart failure (HF) with preserved ejection fraction (HFpEF) typically develop dyspnoea and pulmonary congestion upon exercise. Lung ultrasound (LUS) is a simple diagnostic tool, providing semi-quantitative assessment of extravascular lung water through B-lines. It has been shown that HFpEF patients develop B-lines upon submaximal exercise stress echocardiography; however, whether exercise-induced pulmonary congestion carries prognostic implications is unknown. This study aimed at evaluating the prognostic value of B-line assessment during exercise in HFpEF patients. Methods: Sixty-one I–II NYHA class HFpEF patients underwent standard echocardiography, LUS (28-scanning point method), and B-type natriuretic peptide (BNP) assessment during supine exercise echocardiography (baseline and peak exercise). The primary endpoint was a composite of cardiovascular death or HF hospitalization at one-year. Results: B-lines, E/e’, and BNP significantly increased during exercise (P <0.001 for all). By multivariable analysis, both peak (HR 1.50, 95% CI 1.21–1.85, P <0.001), and change (HR 1.34, 95% CI 1.12–1.62, P =0.002) B-lines were retained as independent predictors of outcome (HRs per 1 B-line increment), along with BNP and E/e’ ratio. Importantly, adding peak B-line on top of a clinical model significantly improved prognostic accuracy (C-index increase=0.157, 0.056 to 0.258, P =0.002), and net reclassification (continuous NRI =0.51, 0.09 to 0.74, P =0.016), with similar results for B-line change. Conclusions: Detection of exercise-induced pulmonary congestion by LUS is an independent predictor of outcome in HFpEF patients; its use may help refining the routine risk-stratification of these patients on top of well-established clinical variables.
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Submitted on : Thursday, June 25, 2020 - 11:02:52 AM
Last modification on : Thursday, January 7, 2021 - 4:00:03 PM
Long-term archiving on: : Wednesday, September 23, 2020 - 4:00:09 PM

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Stefano Coiro, Dejan Simonovic, Marina Deljanin-Ilic, Kévin Duarte, Erberto Carluccio, et al.. Prognostic Value of Dynamic Changes in Pulmonary Congestion During Exercise Stress Echocardiography in Heart Failure With Preserved Ejection Fraction. Circulation. Heart failure, Lippincott Williams & Wilkins, 2020, 13 (6), pp.e006769. ⟨10.1161/CIRCHEARTFAILURE.119.006769⟩. ⟨hal-02880706⟩

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