Pulmonary Congestion During Exercise Stress Echocardiography in Ischemic and Heart Failure Patients
Elisa Merli, Quirino Ciampi, Maria Chiara Scali, A Zagatina, Pablo Merlo, Rosina Arbucci, Clarissa Borguezan Daros, José Luis de Castro e Silva Pretto, Miguel Amor, Michael Salamè, Hugo Mosto, Doralisa Morrone, Antonello D’Andrea, Barbara Reisenhofer, Hugo Rodríguez‐Zanella, Karina Wierzbowska‐Drabik, Jarosław D. Kasprzak, Gergely Ágoston, Albert Varga, Jorge Lowenstein, Claudio Dodi, Lauro Cortigiani, Iana Simova, Martina Samardjieva, Rodolfo Citro, Jelena Čelutkienė, Federica Re, Ines Monte, Suzana Gligorova, Francesco Antonini‐Canterin, Mauro Pepi, Clara Carpeggiani, Patricia A. Pellikka, Eugenio Picano, on behalf of Stress Echo 2020 and 2030 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
Abstract
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. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT 03049995.