Predictive Value of Pre-Discharge Cardiac and Pulmonary Ultrasound in Older Adults Hospitalized for Acute Heart Failure

pp. 127-134

Abstract

Background: Acute heart failure (AHF) remains a major clinical challenge due to its high morbidity and mortality. The use of cardiac and lung ultrasound has been increasingly recognized as valuable tools for the assessment of residual congestion.
Objective: The aim of this study was to assess the usefulness of cardiac and pulmonary congestion ultrasound parameters prior to discharge for identifying patients at risk of readmission and/or death within 180 days following the initial hospitalization.
Methods: This was a prospective study including consecutive patients over 65 years of age admitted with primary diagnosis of AHF. Patients with acute coronary syndromes, severe valvular disease requiring surgery, heart transplantation, and severe pulmonary disorders were excluded. Ultrasound characteristics at hospital discharge were assessed for their association with events during the 180-day follow-up period using univariate and multivariate Cox regression analyses. For B-lines, a ROC curve was generated, and the optimal cutoff point for predicting the primary endpoint was determined using the Youden index.
Results: A total of 200 patients were analyzed. Median age was 81 (interquartile range, IQR, 76–86) years, and 53% were men. During follow-up, 37.5% of patients experienced the composite endpoint of death or rehospitalization for AHF. The ultrasound variables significantly associated with the primary endpoint were the E/e’ ratio (septal and lateral), the presence of dilated inferior vena cava (IVC), pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and the number of B-lines present at hospital discharge (p<0.001). In a multivariate model adjusted for age, sex and ultrasound variables, B-lines at discharge remained significantly associated with the primary outcome. Patients with ≥7 B-lines had a significantly higher incidence of rehospitalization and death within the 180-day follow-up period (p<0.001).
Conclusions: A comprehensive ultrasound-based assessment—including parameters such as septal and lateral E/e’ ratio, PASP, TAPSE, IVC assessment, and B-lines—provides valuable prognostic information at discharge in patients hospitalized for AHF.