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Lung ultrasound in internal medicine efficiently drives the management of patients with heart failure and speeds up the discharge time

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Abstract

Lung ultrasound (LUS) is a valid tool for the assessment of heart failure (HF) through the quantification of the B-lines. This study in HF patients aims to evaluate if LUS: (1) can accelerate the discharge time; (2) can efficiently drive diuretic therapy dosage; and (3) may have better performance compared to the amino-terminal portion of B type natriuretic peptide (NT-proBNP) levels in monitoring HF recovery. A consecutive sample of 120 HF patients was admitted from the Emergency Department (ED) to the Internal Medicine Department (Verona University Hospital). The Chest X-ray (CXR) group underwent standard CXR examination on admission and discharge. The LUS group underwent LUS on admission, 24, 48 and 72 h later, and on discharge. The Inferior Cava Vein Collapsibility Index, ICVCI, and the NT-proBNP were assessed. LUS discharge time was significantly shorter if compared to CXR group (p < 0.01). During hospitalization, the LUS group underwent an increased number of diuretic dosage modulations compared to the CXR group (p < 0.001). There was a stronger association between partial pressure of oxygen in arterial blood (PaO2) and B-lines compared to the association between PaO2 and NT-proBNP both on admission and on discharge (p < 0.001). The B-lines numbers were significantly higher on admission in patients with more severe HF, and the ICVCI was inversely associated with B-lines number (p < 0.001). The potential of LUS in tailoring diuretic therapy and accelerating the discharge time in HF patients is confirmed. Until the technique comes into common use in different departments, it is plausible that LUS will evolve with different facets.

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Abbreviations

CXR:

Chest X-ray

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFmrEF:

Heart failure with mid-range ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

ICVCI:

Inferior Cave Vein Collassability index

LUS:

Lung ultrasound

NT-pro BNP:

Circulating N-terminal pro-hormone of brain natriuretic peptide

NYHA:

New York Heart Association

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Authors and Affiliations

Authors

Contributions

CM and MDDP conceived the study and performed the ultrasound examinations; GP statistically analyzed the data, AT,AN, TM, AF, UG revised the data; LC, AC and MS revised the paper, CM wrote the manuscript.

Corresponding author

Correspondence to Chiara Mozzini.

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Conflict of interest

The authors declare that they have no competing interest.

Statement of human and animal rights

The study was conducted in accordance with the ethical standards laid down in the Helsinki Declaration of 1975 and its late amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Mozzini, C., Di Dio Perna, M., Pesce, G. et al. Lung ultrasound in internal medicine efficiently drives the management of patients with heart failure and speeds up the discharge time. Intern Emerg Med 13, 27–33 (2018). https://doi.org/10.1007/s11739-017-1738-1

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  • DOI: https://doi.org/10.1007/s11739-017-1738-1

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