Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study - Université de Lorraine Access content directly
Journal Articles Clinical Research in Cardiology Year : 2023

Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study

Abstract

Background: Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging despite the use of scores/algorithms. This study intended to assess the diagnostic value of exercise lung ultrasound (LUS) for HFpEF diagnosis. Methods: We studied two independent case-control studies of HFpEF patients and control subjects undergoing different exercise protocols: i) submaximal exercise stress echocardiography (ESE) with LUS performed by expert cardiologists (N=116, HFpEF=65.5%), and ii) maximal cycle ergometer test (CET) (N=54, HFpEF=50%) with LUS performed by unexperienced physicians shortly trained for the study. B-line kinetics (i.e. peak values and their changes from rest) were assessed Results: In the ESE cohort, the C-index (95% CI) of peak B-lines for HFpEF diagnosis was 0.985 (0.968-1.000), whereas the C-index of rest and exercise HFA-PEFF scores (i.e. including stress echo findings) were <0.90 (CI 0.823-0.949), and that of H2FPEF scores was <0.70 (CI 0.558-0.764). The C-index increase of peak B-lines on top of the above-mentioned scores was significant (C-index increase >0.090 and P-value <0.001 for all). Similar results were observed for change Blines. Peak B-line >5 (sensitivity=93.4%, specificity=97.5%) and change B-line >3 (sensitivity=94.7%, specificity=87.5%) were the best cutoffs for HFpEF diagnosis. Adding peak or change B-lines on top of HFpEF scores and BNP significantly improved diagnostic accuracy. Peak B-lines showed a good diagnostic accuracy in the LUS beginner-led CET cohort (C-index=0.713, 0.588-0.838). Conclusions: exercise LUS showed excellent diagnostic value for HFpEF diagnosis regardless of different exercise protocols/level of expertise, with additive diagnostic accuracy on top of available scores and natriuretic peptides.
Fichier principal
Vignette du fichier
Manuscript.pdf (1.15 Mo) Télécharger le fichier
Supplementary Material.pdf (180.41 Ko) Télécharger le fichier
Origin : Files produced by the author(s)

Dates and versions

hal-04102609 , version 1 (22-05-2023)

Identifiers

Cite

Stefano Coiro, Mathieu Echivard, Dejan Simonovic, Kevin Duarte, Mario Santos, et al.. Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study. Clinical Research in Cardiology, 2023, 112 (8), pp.1129-1142. ⟨10.1007/s00392-023-02219-y⟩. ⟨hal-04102609⟩
37 View
41 Download

Altmetric

Share

Gmail Facebook X LinkedIn More