Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography
Maria Chiara Scali, Angela Zagatina, Quirino Ciampi, Lauro Cortigiani, Antonello D'Andrea, Clarissa Borguezan Daros, Nadezhda Zhuravskaya, Jaroslaw D Kasprzak, Karina Wierzbowska-Drabik, José Luis de Castro E Silva Pretto, Ana Djordjevic-Dikic, Branko Beleslin, Marija Petrovic, Nikola Boskovic, Milorad Tesic, Ines Monte, Iana Simova, Martina Vladova, Alla Boshchenko, Alexander Vrublevsky, Rodolfo Citro, Miguel Amor, Paul E Vargas Mieles, Rosina Arbucci, Pablo Martin Merlo, Diego M Lowenstein Haber, Claudio Dodi, Fausto Rigo, Suzana Gligorova, Milica Dekleva, Sergio Severino, Fabio Lattanzi, Doralisa Morrone, Maurizio Galderisi, Marco A R Torres, Alessandro Salustri, Hugo Rodrìguez-Zanella, Fabio Marco Costantino, Albert Varga, Gergely Agoston, Eduardo Bossone, Francesco Ferrara, Nicola Gaibazzi, Jelena Celutkiene, Maciej Haberka, Fabio Mori, Maria Grazia D'Alfonso, Barbara Reisenhofer, Ana Cristina Camarozano, Marcelo Haertel Miglioranza, Ewa Szymczyk, Paulina Wejner-Mik, Katarzyna Wdowiak-Okrojek, Tamara Preradovic-Kovacevic, Tonino Bombardini, Miodrag Ostojic, Aleksandra Nikolic, Federica Re, Andrea Barbieri, Giovanni Di Salvo, Elisa Merli, Paolo Colonna, Valentina Lorenzoni, Michele De Nes, Marco Paterni, Clara Carpeggiani, Jorge Lowenstein, Eugenio Picano, Stress Echo 2020 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging, Maria Chiara Scali, Angela Zagatina, Quirino Ciampi, Lauro Cortigiani, Antonello D'Andrea, Clarissa Borguezan Daros, Nadezhda Zhuravskaya, Jaroslaw D Kasprzak, Karina Wierzbowska-Drabik, José Luis de Castro E Silva Pretto, Ana Djordjevic-Dikic, Branko Beleslin, Marija Petrovic, Nikola Boskovic, Milorad Tesic, Ines Monte, Iana Simova, Martina Vladova, Alla Boshchenko, Alexander Vrublevsky, Rodolfo Citro, Miguel Amor, Paul E Vargas Mieles, Rosina Arbucci, Pablo Martin Merlo, Diego M Lowenstein Haber, Claudio Dodi, Fausto Rigo, Suzana Gligorova, Milica Dekleva, Sergio Severino, Fabio Lattanzi, Doralisa Morrone, Maurizio Galderisi, Marco A R Torres, Alessandro Salustri, Hugo Rodrìguez-Zanella, Fabio Marco Costantino, Albert Varga, Gergely Agoston, Eduardo Bossone, Francesco Ferrara, Nicola Gaibazzi, Jelena Celutkiene, Maciej Haberka, Fabio Mori, Maria Grazia D'Alfonso, Barbara Reisenhofer, Ana Cristina Camarozano, Marcelo Haertel Miglioranza, Ewa Szymczyk, Paulina Wejner-Mik, Katarzyna Wdowiak-Okrojek, Tamara Preradovic-Kovacevic, Tonino Bombardini, Miodrag Ostojic, Aleksandra Nikolic, Federica Re, Andrea Barbieri, Giovanni Di Salvo, Elisa Merli, Paolo Colonna, Valentina Lorenzoni, Michele De Nes, Marco Paterni, Clara Carpeggiani, Jorge Lowenstein, Eugenio Picano, Stress Echo 2020 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging
Abstract
Objectives: The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE).
Background: B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE.
Methods: The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up.
Results: According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction.
Conclusions: Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020-The International Stress Echo Study [SE2020]; NCT03049995).
Keywords: coronary artery disease; heart failure; lung ultrasound; stress echocardiography.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed