Prognostic role of sonographic decongestion in patients with acute heart failure with reduced and preserved ejection fraction: a multicenter study

Abstract: Background: We investigated the role of the dynamic changes of pulmonary congestion, asassessed by sonographic B-lines, as a tool to stratify prognosis in patients admitted for acute heartfailure with reduced and preserved ejection fraction (HFrEF, HFpEF). Methods: In this multicenter,prospective study, lung ultrasound was performed at admission and before discharge by trainedinvestigators, blinded to clinical findings. Results: We enrolled 208 consecutive patients (mean age 76 [95% confidence interval, 70–84] years), 125 with HFrEF, 83 with HFpEF (mean ejection fraction32% and 57%, respectively). The primary composite endpoint of cardiovascular death or HF rehospitalization occurred in 18% of patients within 6 months. In the overall population, independentpredictors of the occurrence of the primary endpoint were thenumber of B-lines at discharge,NT-proBNPlevels,moderatetoseveremitralregurgitation,and inferior vena cava diameter on admission. B-lines at discharge were the only independent predictor in both HFrEF and HFpEFsubgroups. A cut-off of B-lines > 15 at discharge displayed the highest accuracy in predicting theprimary endpoint (AUC = 0.80, p < 0.0001). Halving B-lines during hospitalization further improvedevent classification (continuous net reclassification improvement = 22.8%, p = 0.04). Conclusions: Thepresence of residual subclinical sonographic pulmonary congestion at discharge predicts 6-monthclinical outcomes across the whole spectrum of acute HF patients, independent of conventionalbiohumoral and echocardiographic parameters. Achieving effective pulmonary decongestion during hospitalization is associated with better outcomes