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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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https://hal.univ-lorraine.fr/hal-02880706
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Submitted on : Thursday, June 25, 2020 - 11:02:52 AM
Last modification on : Monday, November 28, 2022 - 5:50:05 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, 2020, 13 (6), pp.e006769. ⟨10.1161/CIRCHEARTFAILURE.119.006769⟩. ⟨hal-02880706⟩

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