Evaluation of lung ultrasound with clinical congestion score in diagnosis and clinical outcome of patients with acute left ventricular failure prospective study
Keywords:Acute heart failure, Clinical Congestion score, Hospital stay, Lung ultrasound, Kerley B. lines
Background: Congestive cardiac failure (CCF) is often a worldwide phenomenon and usually affects millions of people years and is accompanied with high mortality. The present study is undertaken to evaluate the usefulness of Lung Ultrasound Scan in diagnosis and to identify its role as a marker of clinical outcome in patients with Acute LVF.
Methods: A prospective analytical study was undertaken among the patients diagnosed as acute left ventricular failure who were admitted in tertiary care hospital. About 45 patients were enrolled by convenient sampling. The severity of acute LVF will be assessed using Clinical Congestion Score (CCS) and Lung Ultrasound Scan (LUS) based degree of congestion within 6 hours of admission, day 01 of admission and 24 hours before discharge.
Results: The mean clinical congestion score was 5.36 at the time of admission. The Kerley B line at the time of admission was 15.93. The mean Kerley B line was 20.41 in the patients with clinical congestion score of more than 3.The mean Kerley B score after 24 hours of discharge was 19.69 and 5.69 during discharge among the patients with severe LV dysfunction. The mean Kerley B line score was higher at the time of admission which was statistically significant at the time of admission and within 24 hours after admission in patients with readmission.
Conclusions: The mean clinical congestion scores and Kerley B lines were higher during the admission which rapidly decreased before discharge. There was a positive correlation between the Clinical congestion scores and Kerley B lines.
Ansari N, Hasan A, Owais M, A study of inflammatory markers and their correlation with severity in patients with chronic heart failure, Biomedical Research: 2012:23(3):408-15.
Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Cardiac Failure Review. 2017;3(1):7-11.
Stewart S, Wilkinson D, Hansen C, Vaghela V, Mvungi R, McMurray J, et al. Predominance of heart failure in the Heart of Soweto Study cohort: emerging challenges for urban African communities. Circulation. 2008 Dec. 2;118(23):2360-7.
Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D, et al. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries. Arch Intern Med. 2012 Oct 8;172(18):1386-94.
Nadar S, Prasad N, Taylor RS, Lip GY. Positive pressure ventilation in the management of acute and chronic cardiac failure: a systematic review and meta-analysis. Int J Cardiol. 2005;99(2):171-85.
Mant J, Doust J, Roalfe A, Barton P, Cowie MR, Glasziou P, et al, Systematic review and individual patient data meta-analysis of diagnosis of heart failure, with modelling of implications of diagnostic strategies in primary care. Health Technol Assess: 2009:13(32);1-248.
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al, International evidence-based recommendations for point-of-care lung ultrasound.Intensive Care Med: 2012:38(4):577-91.
Cook DJ, Simel DL, Does this patient have abnormal central venous pressure? JAMA: 1996: 275(8);630-4.
Aras MA, Teerlink JR, Lung ultrasound: a B-line to the prediction of decompensated heart failure. Europ Heart J. 2016:(37):1252-4.
Anderson KLI, Jenq KY, Panebianco NL, Dean AJ, Diagnosing heart failure failure among acutely dyspneic patients with cardiac,inferiorvenacava and lung ultrasonography, Am J Emerg Med: 2013:31(8);1208-14
Miglioranza MH, Gargani L, Sant'Anna RT, Rover MM, Martins VM, Mantovani A, et al, Lung ultrasound for the evaluation of pulmonary congestion in outpatients, JACC: Cardiovascular Imaging: 2013:6(11):1141-51.
Coiro S, Rossignol P, Ambrosio G, Carluccio E, Alunni G, Murrone A, et al, Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure, Eur J Heart Failure. 2015 Nov;17(11):1172-81.
Prosen G, Klemen P, Strnad M, Grmec Š. Combination of lung ultrasound (a comet – tail sign and N – Terminal probrain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting, Critical care: 2011 Apr;15(2):R114.
Platz E, Lewis EF, Uno H, Peck J, Pivetta E, Merz AA et al, Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients, Eur Heart J: 2016 Apr 14;37(15):1244-51.