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DYNAMIC OF BEDSIDE ULTRASOUND VENOUS AND PULMONARY CONGESTION ASSESSMENT IN PATIENTS WITH ARTERIAL HYPERTENSION AND DECOMPENSATED HEART FAILURE.
Journal of Hypertension 2022 June 2
OBJECTIVE: arterial hypertension is a major pandemic in the modern world and is a common cause of heart failure. Identification of pulmonary and venous congestion is relevant in patients with arterial hypertension(AH) and decompensated heart failure (DHF).
DESIGN AND METHOD: to assess the severity and dynamics of venous congestion (VC) by VExUS (including the study of the inferior vena cava (IVC), porto-hepatic and renal blood flow), and pulmonary congestion (PC) by LUS (with B-lines assessment according to 8-zone method) in patients with AH and DHF at admission to hospital and at discharge. The PC was defined as the sum of B-lines of more than 5 (6-15, 16-30 and> 30 - light, moderate and severe pulmonary congestion, respectively). Standard examinations and assessment of VC and LUS were performed in 52 patients with AH and DHF in the first 48 hours after admission and at discharge (men 48%, age 70 ± 11 years (M ± SD), atrial fibrillation 60%, diabetes 40%, chronic anemia 27%, left ventricle ejection fraction (LVEF) 50 [40; 57] %, EF < 40% - 29%, NTproBNP 1421 [754; 2024] pg/ml (Me; IQR)). To assess the severity of clinical symptoms and signs of congestion, the composite congestion score (CCS) was assessed: 0 - no congestion; 1-2-moderate; > = 3 severe congestion.
RESULTS: at admission, 27% of patients had moderate congestion according to CCS scale, 65% had severe congestion. In 31%, 13% and 17% of patients, mild, moderate and severe VC was revealed, respectively. Mild, moderate and severe PC was detected in 21%, 27% and 48% of patients, respectively. Congestion was present in 50% of patients at discharge according to CCS scale (moderate-42%, severe-8%). VC persisted in 38% of patients:mild in 20%, moderate-in 12%, severe-in 6% of cases. At discharge, PC was still present in 44% of patients. 15% of patients had mild PC, 20%-moderate and 9%-severe. VC and PC significantly correlated with NT-proBNP (r = 0.3,p = 0.03 and r = 0.41,p = 0.003,respectively) and with each other (r = 0.35,p = 0.01).
CONCLUSIONS: Correlations between venous congestion assessed by VEXUS protocol and PC by LUS with NtproBNP in patients with AH and DHF were revealed.
DESIGN AND METHOD: to assess the severity and dynamics of venous congestion (VC) by VExUS (including the study of the inferior vena cava (IVC), porto-hepatic and renal blood flow), and pulmonary congestion (PC) by LUS (with B-lines assessment according to 8-zone method) in patients with AH and DHF at admission to hospital and at discharge. The PC was defined as the sum of B-lines of more than 5 (6-15, 16-30 and> 30 - light, moderate and severe pulmonary congestion, respectively). Standard examinations and assessment of VC and LUS were performed in 52 patients with AH and DHF in the first 48 hours after admission and at discharge (men 48%, age 70 ± 11 years (M ± SD), atrial fibrillation 60%, diabetes 40%, chronic anemia 27%, left ventricle ejection fraction (LVEF) 50 [40; 57] %, EF < 40% - 29%, NTproBNP 1421 [754; 2024] pg/ml (Me; IQR)). To assess the severity of clinical symptoms and signs of congestion, the composite congestion score (CCS) was assessed: 0 - no congestion; 1-2-moderate; > = 3 severe congestion.
RESULTS: at admission, 27% of patients had moderate congestion according to CCS scale, 65% had severe congestion. In 31%, 13% and 17% of patients, mild, moderate and severe VC was revealed, respectively. Mild, moderate and severe PC was detected in 21%, 27% and 48% of patients, respectively. Congestion was present in 50% of patients at discharge according to CCS scale (moderate-42%, severe-8%). VC persisted in 38% of patients:mild in 20%, moderate-in 12%, severe-in 6% of cases. At discharge, PC was still present in 44% of patients. 15% of patients had mild PC, 20%-moderate and 9%-severe. VC and PC significantly correlated with NT-proBNP (r = 0.3,p = 0.03 and r = 0.41,p = 0.003,respectively) and with each other (r = 0.35,p = 0.01).
CONCLUSIONS: Correlations between venous congestion assessed by VEXUS protocol and PC by LUS with NtproBNP in patients with AH and DHF were revealed.
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