TY - JOUR
T1 - Pulmonary Congestion During Exercise Stress Echocardiography in Ischemic and Heart Failure Patients
AU - on behalf of Stress Echo 2020 and 2030 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
AU - Merli, Elisa
AU - Ciampi, Quirino
AU - Scali, Maria Chiara
AU - Zagatina, Angela
AU - Merlo, Pablo Martin
AU - Arbucci, Rosina
AU - Daros, Clarissa Borguezan
AU - de Castro e Silva Pretto, José Luis
AU - Amor, Miguel
AU - Salamè, Michael F.
AU - Mosto, Hugo
AU - Morrone, Doralisa
AU - D’Andrea, Antonello
AU - Reisenhofer, Barbara
AU - Rodriguez-Zanella, Hugo
AU - Wierzbowska-Drabik, Karina
AU - Kasprzak, Jaroslaw
AU - Agoston, Gergely
AU - Varga, Albert
AU - Lowenstein, Jorge
AU - Dodi, Claudio
AU - Cortigiani, Lauro
AU - Simova, Iana
AU - Samardjieva, Martina
AU - Citro, Rodolfo
AU - Celutkiene, Jelena
AU - Re, Federica
AU - Monte, Ines
AU - Gligorova, Suzana
AU - Antonini-Canterin, Francesco
AU - Pepi, Mauro
AU - Carpeggiani, Clara
AU - Pellikka, Patricia A.
AU - Picano, Eugenio
N1 - Publisher Copyright:
© 2022 American Heart Association, Inc.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - BACKGROUND: Lung ultrasound detects pulmonary congestion as B-lines at rest, and more frequently, during exercise stress echocardiography (ESE). METHODS: We performed ESE plus lung ultrasound (4-site simplified scan) in 4392 subjects referred for semi-supine bike ESE in 24 certified centers in 9 countries. B-line score ranged from 0 (normal) to 40 (severely abnormal). Five different populations were evaluated: control subjects (n=103); chronic coronary syndromes (n=3701); heart failure with reduced ejection fraction (n=395); heart failure with preserved ejection fraction (n=70); ischemic mitral regurgitation ≥ moderate at rest (n=123). In a subset of 2478 patients, follow-up information was available. RESULTS: During ESE, B-lines increased in all study groups except controls. Age, hypertension, abnormal ejection fraction, peak wall motion score index, and abnormal heart rate reserve were associated with B-lines in multivariable regression analysis. Stress B lines (hazard ratio, 2.179 [95% CI, 1.015–4.680]; P=0.046) and ejection fraction <50% (hazard ratio, 2.942 [95% CI, 1.268–6.822]; P=0.012) were independent predictors of all-cause death (n=29 after a median follow-up of 29 months). CONCLUSIONS: B-lines identify the pulmonary congestion phenotype at rest, and more frequently, during ESE in ischemic and heart failure patients. Stress B-lines may help to refine risk stratification in these patients.
AB - BACKGROUND: Lung ultrasound detects pulmonary congestion as B-lines at rest, and more frequently, during exercise stress echocardiography (ESE). METHODS: We performed ESE plus lung ultrasound (4-site simplified scan) in 4392 subjects referred for semi-supine bike ESE in 24 certified centers in 9 countries. B-line score ranged from 0 (normal) to 40 (severely abnormal). Five different populations were evaluated: control subjects (n=103); chronic coronary syndromes (n=3701); heart failure with reduced ejection fraction (n=395); heart failure with preserved ejection fraction (n=70); ischemic mitral regurgitation ≥ moderate at rest (n=123). In a subset of 2478 patients, follow-up information was available. RESULTS: During ESE, B-lines increased in all study groups except controls. Age, hypertension, abnormal ejection fraction, peak wall motion score index, and abnormal heart rate reserve were associated with B-lines in multivariable regression analysis. Stress B lines (hazard ratio, 2.179 [95% CI, 1.015–4.680]; P=0.046) and ejection fraction <50% (hazard ratio, 2.942 [95% CI, 1.268–6.822]; P=0.012) were independent predictors of all-cause death (n=29 after a median follow-up of 29 months). CONCLUSIONS: B-lines identify the pulmonary congestion phenotype at rest, and more frequently, during ESE in ischemic and heart failure patients. Stress B-lines may help to refine risk stratification in these patients.
KW - coronary artery disease
KW - echocardiography
KW - heart failure
KW - hypertension
KW - lung
KW - stress echocardiography
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U2 - 10.1161/CIRCIMAGING.121.013558
DO - 10.1161/CIRCIMAGING.121.013558
M3 - Article
C2 - 35580160
AN - SCOPUS:85130138086
SN - 1941-9651
VL - 15
SP - 304
EP - 313
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
IS - 5
ER -