Pulmonary congestion assessed by lung ultrasound in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: Prevalence and prognostic implications,European Journal of Heart Failure

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Pulmonary congestion assessed by lung ultrasound in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: Prevalence and prognostic implications
European Journal of Heart Failure ( IF 16.9 ) Pub Date : 2024-07-17 , DOI: 10.1002/ejhf.3365
Rosa Lillo _{1,

2} , Stefano Cangemi ₂ , Francesca Graziani ₁ , Gabriella Locorotondo ₁ , Daniela Pedicino ₁ , Cristina Aurigemma ₁ , Enrico Romagnoli ₁ , Silvia Malara ₂ , Maria Chiara Meucci ₁ , Giulia Iannaccone _{1,

2} , Francesco Bianchini ₁ , Marialisa Nesta ₁ , Piergiorgio Bruno _{1,

2} , Antonella Lombardo _{1,

2} , Carlo Trani _{1,

2} , Francesco Burzotta _{1,

2}

Affiliation

AimsLung ultrasound (LUS) is a sensitive tool to assess pulmonary congestion (PC). Few data are available on LUS‐PC evaluation in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the prevalence and prognostic impact of LUS‐PC in patients with severe AS before and after TAVI.Methods and resultsWe designed a single‐centre prospective study in patients referred for TAVI for severe AS (ClinicalTrials.gov identification number: NCT05024942). All patients underwent echocardiography and LUS (according to a simplified 8‐zone scanning protocol) the day before and within 72 h after the procedure. The primary endpoint was the composite of all‐cause mortality, hospitalization for heart failure and urgent medical visits for worsening dyspnoea at 12‐month follow‐up. A total of 127 patients were enrolled (mean age 81.1 ± 5.8 years; 54.3% female). Pre‐TAVI LUS‐PC was documented in 65 patients (51%). After TAVI, the prevalence of LUS‐PC significantly decreased as compared to pre‐TAVI evaluation, being documented in only 28 patients (22% vs. 51%, p < 0.001) with a median B‐lines score of 4 (interquartile range [IQR] 0–11) versus 11 (IQR 6–19) pre‐TAVI (p < 0.001). During a median follow‐up of 12 (12–17) months, 25 patients (19.6%) met the composite endpoint. On multivariable Cox regression analysis, pre‐TAVI LUS‐PC was independently associated with cardiovascular events (hazard ratio 2.764, 95% confidence interval 1.114–6.857; p = 0.028).ConclusionsLung ultrasonography reveals a high prevalence of PC in patients with severe AS undergoing TAVI, which is significantly reduced by the procedure. Pre‐TAVI PC, measured by LUS, is an independent predictor of 1‐year clinical outcome.

中文翻译：

通过肺部超声评估接受经导管主动脉瓣植入的严重主动脉瓣狭窄患者的肺充血：患病率和预后意义

Aims 肺超声 (LUS) 是评估肺充血 (PC) 的敏感工具。关于接受经导管主动脉瓣植入术 (TAVI) 的严重主动脉瓣狭窄 (AS) 患者的 LUS-PC 评估数据很少。本研究的目的是评估 TAVI 前后 LUS-PC 在严重 AS 患者中的患病率和预后影响。方法和结果我们针对因严重 AS 转诊接受 TAVI 的患者设计了一项单中心前瞻性研究（临床试验网识别号：NCT05024942）。所有患者在手术前一天和手术后 72 小时内均接受超声心动图和 LUS（根据简化的 8 区扫描方案）。主要终点是 12 个月随访时全因死亡率、因心力衰竭住院以及因呼吸困难恶化而紧急就诊的综合终点。共有 127 名患者入组（平均年龄 81.1 ± 5.8 岁；54.3% 为女性）。 65 名患者 (51%) 记录了 TAVI 前 LUS-PC。 TAVI 后，与 TAVI 前评估相比，LUS-PC 的患病率显着下降，仅在 28 名患者中得到记录（22% vs. 51%， p < 0.001），中位 B 线得分为 4（四分位数间距 [IQR] 0-11），而 TAVI 前则为 11（IQR 6-19）（ p < 0.001）。在中位随访 12 (12-17) 个月期间，25 名患者 (19.6%) 达到了复合终点。在多变量 Cox 回归分析中，TAVI 前 LUS-PC 与心血管事件独立相关（风险比 2.764，95% 置信区间 1.114–6.857； p = 0.028）。结论肺部超声检查显示接受 TAVI 的严重 AS 患者 PC 患病率较高，该手术显着降低了 PC 患病率。通过 LUS 测量的 TAVI 前 PC 是 1 年临床结果的独立预测因子。

更新日期：2024-07-17

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