PICCO PROJECT - Persistent pulmonary congestion before...

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Persistent pulmonary congestion before  discharge predicts rehospitalization in  heart failure: a lung ultrasound study  Luna  Gargani1*, P. S. Pang2, F. Frassi3, M.H. Miglioranza4, F. L. Dini5, P. Landi1 and E. Picano1 Abstract Background: B-lines evaluated by lung ultrasound (LUS) are the sonographic  sign of pulmonary congestion, a major predictor of morbidity and mortality in  patients with heart failure (HF). Our aim was to assess the prognostic value of B- lines at discharge to predict rehospitalization at 6 months in patients with acute  HF (AHF). Methods: A prospective cohort of 100 patients admitted to a Cardiology  Department for dyspnea and/or clinical suspicion of AHF were enrolled (mean  age 70  ±  11 years). B-lines were evaluated at admission and before discharge.  Subjects were followed-up for 6-months after discharge. Results: Mean B-lines at admission was 48  ±  48 with a statistically significant  reduction before discharge (20  ±  23, p < .0001). During follow-up, 14 patients  were rehospitalized for decompensated HF. The 6-month event-free survival was highest in patients with less B-lines (  15) and lowest in patients with more B- lines (> 15) (log rank  2 20.5, p < .0001). On multivariable analysis, B-lines > 15  χ before discharge (hazard ratio [HR] 11.74; 95 % confidence interval [CI] 1.30– 106.16) was an independent predictor of events at 6 months. Conclusions: Persistent pulmonary congestion before discharge evaluated by  ultrasound strongly predicts rehospitalization for HF at 6-months. Absence or a  mild degree of B-lines identify a subgroup at extremely low risk to be readmitted  for HF decompensation. Keywords: Lung ultrasound, B-lines, Ultrasound lung comets, Pulmonary  congestion, Prognosis, Rehospitalization Introduction Heart failure (HF) afflicts 1 2 % of people in the western world, with an incidence of 5 10 per 1000 persons per year [1]. Acute heart failure (AHF) is the most common reason  for hospitalization in patients aged > 65 years [2, 3]. Despite significant improvement in  signs and symptoms during hospitalization, post-discharge outcomes for patients hospi-  talized for AHF are poor. Up to 25 % of AHF patients are readmitted within 30 days of  discharge, with a high mortal- ity rate during this period [4]. Pulmonary congestion is a major predictor of morbid- ity and mortality in HF [5]. It is the single most import- ant contributor to hospitalization, more significant than * Correspondence:  [email protected]  1National Research Council of Pisa,  Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy Full list of 
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