Imaging Congestion With a Pocket Ultrasound Device: Prognostic Implications in Patients With Chronic Heart Failure

• Pocket-sized handheld ultrasound devices can be used to detect signs of decompensation in patients with HF as demonstrated by comet tail artifacts (CTA) or pleural effusion (PE).
• In stable outpatients with chronic HF, a pocket-sized hand-held ultrasound examination found that 24% had CTA and 10% had PE.
• CTA and PE had significant but weak associations with NT-proBNP and NYHA functional class.
• CTA or having CTA and/or PE was, after adjustment for age, left-ventricular dysfunction <40%, and NT-proBNP, predictive for hospitalizations or death or during a median of 530 days' follow-up.

BackgroundVenous congestion is common in patients with chronic heart failure (HF). We used a pocket-sized ultrasound imaging device (PID) to assess the patients' congestive status and related our findings to prognosis.Methods and ResultsOne hundred four consecutive outpatients from an HF outpatient clinic were studied. Interstitial lung water (ILW), pleural effusion (PE), and the diameter of the inferior vena cava (VCI) were assessed with the use of a PID. ILW was assessed by demonstration of B-lines (comet tail artifact (CTA). Out of the 104 patients, 28 had CTA and 8 had PE. Median VCI diameter was 18 mm (interquartile range 14–22 mm). Each of these parameters correlated weakly (r = 0.26–0.37; P < .05) with the HF biomarker N-terminal pro–B-type natriuretic peptide (NT-proBNP). During the median follow-up time of 530 days, 18 hospitalizations and 14 deaths were registered. Findings of CTA, PE, or both increased the risk of death or hospitalization (hazard ratio 3–4; P < .05). After adjustment for age, cardiac systolic function, and NT-proBNP, this difference remained significant for CTA alone and CTA + PE combined, but not for PE alone.ConclusionsWith the use of a handheld ultrasound device, signs of pulmonary congestion could be demonstrated. When found, these had a significant prognostic impact in clinically stable HF.