Prognostic impact of lung ultrasound detected B-Line on hospitalized ischemic HFmrEF patients

Abstract Background The prognostic impact of lung ultrasound derived B-Line (LU-BL) in heart failure patients with mildly reduced left ventricular ejection fraction (HFmrEF) remains elusive. We evaluated the correlation between LU-BL and prognosis in HFmrEF patients. Methods This study screened consecutive hospitalized HFmrEF patients in our hospital between January 2015 and August 2020 with LU-BL results at admission. LU-BL results at admission were available in 610 HFmrEF patients, and majority patients were diagnosed as ischemic HFmrEF (574, 94.1%). We thus observed the prognostic impact of LU-BL on ischemic HFmrEF patients. Patients completed at least one year of clinical follow-up through telephone, clinical or community visits after discharge. The primary endpoint was defined as the composite endpoint of cardiovascular (CV) death or heart failure hospitalization (CV event) at 90 days and 1-year post discharge. Results CV event at 90 days were significantly higher with higher LU-BL number (0; 1-2; 3-9; ≥10: 12.8%, 11.9%, 14.3% and 28.9%, P<0.001). Kaplan-Meier curves showed LU-BL >6 was associated with increased CV event at 90 days (Log rank P<0.001) and at 1 year (Log rank P = 0.029). After adjusted for clinical and echocardiographic covariates, multivariable Cox regression analysis showed that LU-BL>6 (HR 1.036, 95% CI 1.011-1.062, P = 0.005) and LU-BL >11 (HR 1.882, 95% CI 1.225-2.891, P = 0.004) were independently associated with increased CV event rate at 90 days. The lowest CV event rate at 90 days post discharge was identified in patients with LU-BL<11 and free of diabetes (10.4%). Presence of diabetes was associated with 2-fold higher CV event rate at 90 days post discharge in ischemic HFmrEF patients with LU-BL ≤11 (20.3%). Conclusions LU-BL>6 and 11 is independently related worse cardiovascular outcome at 90 days post discharge in ischemic HFmrEF patients. Diabetes is a fundamental risk factor of worse cardiovascular outcome within 90 days post discharge in ischemic HFmrEF patients with LU-BL<11.LU-BL and outcome of ischemic HFmrEF