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Platz E, Claggett B, Jering KS, Kovacs A, Cikes M, Winzer EB, Rad A, Lefkowitz M, Gong J, Kober L, McMurray JJV, Solomon SD, Shah A. Trajectory of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction and association with cardiac structure and function. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The PARADISE-MI trial examined the efficacy of sacubitril/valsartan in patients with acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion or both. Little is known about the trajectory and echocardiographic correlates of pulmonary congestion in this population.
Purpose
We sought to assess the trajectory of pulmonary congestion using lung ultrasound (LUS) and its association with cardiac structure and function in a subset of patients enrolled in PARADISE- MI.
Methods
Participants underwent 8-zone LUS at baseline and 8 months. B-lines were quantified offline, blinded to treatment group, clinical findings, timepoint and outcomes by a core laboratory. Paired t-tests, chi-squared tests, and linear regression analyses were conducted.
Results
Among 152 patients (median age 65 years, 32% women, 35% obese, mean LVEF 41%), any B-lines were detectable in 87%, the median sum of B-lines in 8 zones was 4 [IQR 2–8], and 67% had ≥3 B-lines indicative of congestion. Greater number of B-lines at baseline was associated with larger left atrial (LA) size, higher E/e' and E/A ratios, greater degree of mitral regurgitation, worse right ventricular (RV) systolic function, and higher tricuspid regurgitation velocity (P trend <0.05 for all) (Figure 1). Among 115 patients with 8-month LUS data, there was a significant decline in number of B-lines from baseline (mean ± SD: −1.6±7.3; p=0.018). Adjusted for baseline, B-lines at follow-up were on average 6 (95% CI: 3, 9) higher in a patient who experienced an intercurrent heart failure (HF) event than a non-HF patient (p=0.001). Among 75 patients with ≥3 B-lines at baseline, a decrease in B-lines to <3, indicating decongestion, occurred in 37% and was similar in the sacubitril/valsartan and ramipril groups (36% vs. 39%, p=0.83).
Conclusions
In this post-AMI cohort, sonographic B-lines, indicating pulmonary congestion, were common at baseline and were significantly higher at follow-up in those who developed HF. Worse pulmonary congestion at baseline was associated with prognostically important echocardiographic markers of LV filling pressure, pulmonary pressure, and RV function.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis
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Affiliation(s)
- E Platz
- Brigham and Women's Hospital , Boston , United States of America
| | - B Claggett
- Brigham and Women's Hospital , Boston , United States of America
| | - K S Jering
- Brigham and Women's Hospital , Boston , United States of America
| | - A Kovacs
- Semmelweis University , Budapest , Hungary
| | - M Cikes
- University Hospital Centre Zagreb , Zagreb , Croatia
| | - E B Winzer
- Heart Center - University Hospital Dresden , Dresden , Germany
| | - A Rad
- Brigham and Women's Hospital , Boston , United States of America
| | - M Lefkowitz
- Novartis , East Hanover , United States of America
| | - J Gong
- Novartis , East Hanover , United States of America
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J J V McMurray
- Cardiovascular Research Centre of Glasgow , Glasgow , United Kingdom
| | - S D Solomon
- Brigham and Women's Hospital , Boston , United States of America
| | - A Shah
- Brigham and Women's Hospital , Boston , United States of America
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