Lung ultrasound predicts heart failure in patients with acute myocardial infarction: comparison of 2 independent trials

Abstract

Introduction and objectives:Lung ultrasound (LUS)predicts heart failure (HF) in patients with acute myocardial infarction(AMI);however,its reproducibility has been poorly evaluated.Our objectives were to compare 2 trials that evaluated the usefulness of LUS in AMI and analyze the combined data to estimate its prognostic value.Methods:Study A was carried out at the Hospital Universitario Virgen Macarena,Seville,Spain,
between February 2017 and February 2018.Study B was carried out at the Instituto de Cardiología“Juana F. Cabral”,Corrientes,Argentina,between March and November 2019.Both included patients with AMI without HF on admission.In-hospital endpoints were HF,defined by progression to Killip ≥2,and death (IHM).Results: Study A included 103 patients and study B, 200.In study A,there was a lower frequency of arterial hypertension (p=0.003),lower systolic (p=0.0001)and diastolic(p=0.003) blood pressure,lower ejection fraction(p=0.034) and more positive sectors in LUS(1.09±2.2 vs 0.47±1.3;p=0.017).The incidence of HF in study A and B was 14.6% vs 12.5%(p=0.3)and of IHM was 4.9% and 2.5%(p=0.3),respectively.In patients with and without HF,the median number of positive sectors in study A was 5 (interquartile range [IQR]=5) vs 0 (IQR=0), p=0.0001 and in study B it was 2 (IQR=4) vs 0 (IQR=0),p=0.0001.In the combined analysis, the area under the ROC curve of LUS to predict HF was 0.83 and for mortality 0.90. In multivariate analysis, LUS was an independent predictor of HF (OR=1.9; p=0.0001) and IHM (OR=1.61; p=0.01).Conclusions:Two independent studies showed, despite clinical differences,the usefulness of LUS to predict HF and IHM in patients with AMI.The predictive usefulness in the combined analysis reinforces the relevance of this simple method in the evaluation of these patients.