Guiding Acute Heart Failure Treatment by Point-of-Care Ultrasound: Validation of a Score Combining Lung Ultrasound and Venous Excess Ultrasound

Abstract

Objectives: Point-of-care ultrasound (POCUS) emerged as a promising tool to evaluate acute decompensated heart failure (ADHF). We propose a POCUS score combining lung and systemic congestion for ADHF assessment. Methods: Patients admitted to the cardiac intensive care unit (CICU) with a diagnosis of ADHF and left ventricular ejection fraction (LVEF) <50% were included. Patient data and POCUS assessment were collected at baseline, after 72 hours, and at CICU discharge. A dynamic ultrasound congestion score (DUCS) incorporating modified venous excess ultrasound score and lung ultrasound was created. We evaluated DUCS by multivariate predictive models, receiver operating characteristic (ROC) area under the curve (AUC), calibration, and net reclassification improvement (NRI) analysis. Results: Patients (n = 109) were mostly male (67.8%), with a mean age of 64.5 years and mean LVEF of 25%. Delta DUCS (∆DUCS) from CICU admission up to 72 hours was an independent predictor of in-hospital mortality (odds ratio [OR] = 0.66, p =.009; ROC AUC = 0.76). DUCS at CICU discharge was an independent predictor of 30-day mortality and readmission (OR = 1.61, p =.001; ROC AUC = 0.77). Both ∆DUCS in 72 hours and DUCS at CICU discharge had good accuracy, in addition to adequate calibration metrics based on observed to expected ratio and performance. DUCS also improved NRI compared to a multivariate predictive model for in-hospital mortality (5.4%) and 30-day mortality and readmission (22.5%). Conclusions: DUCS was an independent predictor of in-hospital mortality and of 30-day mortality and hospital readmission, representing a potentially useful tool to assess ADHF and treatment response.