Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study.

Autor: Coiro S; Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy.; Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France., Echivard M; Département de Cardiologie, CHRU de Nancy, 54500, Vandœuvre-lès-Nancy, France., Simonovic D; Institute for Treatment and Rehabilitation 'Niska Banja', Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia., Duarte K; Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France., Santos M; Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal.; ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal., Deljanin-Ilic M; Institute for Treatment and Rehabilitation 'Niska Banja', Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia., Kobayashi M; Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France., Ambrosio G; Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.; CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia School of Medicine, Perugia, Italy., Girerd N; Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France. nicolas_girerd@yahoo.com.
Jazyk: angličtina
Zdroj: Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2023 Aug; Vol. 112 (8), pp. 1129-1142. Date of Electronic Publication: 2023 May 21.
DOI: 10.1007/s00392-023-02219-y
Abstrakt: Background: Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging despite the use of scores/algorithms. This study intended to assess the diagnostic value of exercise lung ultrasound (LUS) for HFpEF diagnosis.
Methods: We studied two independent case-control studies of HFpEF patients and control subjects undergoing different exercise protocols: (i) submaximal exercise stress echocardiography (ESE) with LUS performed by expert cardiologists (N = 116, HFpEF = 65.5%), and (ii) maximal cycle ergometer test (CET) (N = 54, HFpEF = 50%) with LUS performed by unexperienced physicians shortly trained for the study. B-line kinetics (i.e. peak values and their changes from rest) were assessed.
Results: In the ESE cohort, the C-index (95% CI) of peak B-lines for HFpEF diagnosis was 0.985 (0.968-1.000), whereas the C-index of rest and exercise HFA-PEFF scores (i.e. including stress echo findings) were < 0.90 (CI 0.823-0.949), and that of H2FPEF score was < 0.70 (CI 0.558-0.764). The C-index increase of peak B-lines on top of the above-mentioned scores was significant (C-index increase > 0.090 and P-value < 0.001 for all). Similar results were observed for change B-lines. Peak B-lines > 5 (sensitivity = 93.4%, specificity = 97.5%) and change B-lines > 3 (sensitivity = 94.7%, specificity = 87.5%) were the best cutoffs for HFpEF diagnosis. Adding peak or change B-lines on top of HFpEF scores and BNP significantly improved diagnostic accuracy. Peak B-lines showed a good diagnostic accuracy in the LUS beginner-led CET cohort (C-index = 0.713, 0.588-0.838).
Conclusions: Exercise LUS showed excellent diagnostic value for HFpEF diagnosis regardless of different exercise protocols/level of expertise, with additive diagnostic accuracy on top of available scores and natriuretic peptides.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
Externí odkaz: