Heart failure & cardiomyopathies
The incremental value of multi-organ assessment of congestion using ultrasound in outpatients with heart failure
Authors' conclusion
Simultaneous assessment of pulmonary, venous, and kidney congestion by ultrasound is feasible, fast, and identifies a high prevalence of sub-clinical congestion associated with poor outcomes.
Study context
- Population
- Heart failure (HF) outpatients (median age 77 years, median NT-proBNP 1037 ng/L, 51% left ventricular ejection fraction (LVEF) <50%)310 HF, 101 without HF
- Exposure
- HF outpatients by number of ultrasound signs of congestion vs patients without HF
- No HFn = 101reference
- Outcome
- Death or HF hospitalisation
- Follow-up
- Median 13 (IQR 6-15) months
Methodological detailsUltrasound congestion: IVC ≥21 mm, highest tertile of lung B-lines, or discontinuous renal venous flow
- Ultrasound congestion: IVC ≥21 mm, highest tertile of lung B-lines, or discontinuous renal venous flow
Main finding
As reported in the abstract
median 13 months
Each group vs no HFHazard ratio (95% CI)
HF without ultrasound congestion
1.02(0.86–1.35)
≥2 ultrasound signsafter adjusting for clinical variables and NT-proBNP
26.7(12.4–63.6)
- Patients died or hospitalised for HF
- 77 (19%)
Observational data: associations, not effects.
Further findings
Sub-clinical congestion: ≥1 ultrasound sign among HF without clinical signs of congestion
- No clinical signs of congestion
- 224 (72%)
- ≥1 ultrasound sign of congestion among these
- 95 (42%)
- P < 0.0001
Net reclassification improvement adding multi-organ ultrasound to clinical model incl. NT-proBNP
- NRI
- 28%
- P = 0.03
Characteristics of HF with ≥2 ultrasound signs
- Older, greater neurohormonal activation, lower urinary sodium, larger left atria despite similar LVEF
Original publication
The incremental value of multi-organ assessment of congestion using ultrasound in outpatients with heart failure. Eur Heart J Cardiovasc Imaging. Published 3 January 2023. doi:10.
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