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)
Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography / Scali, M. C.; Zagatina, A.; Ciampi, Q.; Cortigiani, L.; D'Andrea, A.; Daros, C. B.; Zhuravskaya, N.; Kasprzak, J. D.; Wierzbowska-Drabik, K.; Luis de Castro e Silva Pretto, J.; Djordjevic-Dikic, A.; Beleslin, B.; Petrovic, M.; Boskovic, N.; Tesic, M.; Monte, I.; Simova, I.; Vladova, M.; Boshchenko, A.; Vrublevsky, A.; Citro, R.; Amor, M.; Vargas Mieles, P. E.; Arbucci, R.; Merlo, P. M.; Lowenstein Haber, D. M.; Dodi, C.; Rigo, F.; Gligorova, S.; Dekleva, M.; Severino, S.; Lattanzi, F.; Morrone, D.; Galderisi, M.; Torres, M. A. R.; Salustri, A.; Rodriguez-Zanella, H.; Costantino, F. M.; Varga, A.; Agoston, G.; Bossone, E.; Ferrara, F.; Gaibazzi, N.; Celutkiene, J.; Haberka, M.; Mori, F.; D'Alfonso, M. G.; Reisenhofer, B.; Camarozano, A. C.; Miglioranza, M. H.; Szymczyk, E.; Wejner-Mik, P.; Wdowiak-Okrojek, K.; Preradovic-Kovacevic, T.; Bombardini, T.; Ostojic, M.; Nikolic, A.; Re, F.; Barbieri, A.; Di Salvo, G.; Merli, E.; Colonna, P.; Lorenzoni, V.; De Nes, M.; Paterni, M.; Carpeggiani, C.; Lowenstein, J.; Picano, E.. - In: JACC. CARDIOVASCULAR IMAGING. - ISSN 1936-878X. - 13:10(2020), pp. 2085-2095. [10.1016/j.jcmg.2020.04.020]
Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography
Citro R.;Rigo F.;Severino S.;Lattanzi F.;Morrone D.;Galderisi M.;Bossone E.;
2020
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)I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
