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Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study

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Abstract

Background

Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging despite the use of scores/algorithms. This study intended to assess the diagnostic value of exercise lung ultrasound (LUS) for HFpEF diagnosis.

Methods

We studied two independent case–control studies of HFpEF patients and control subjects undergoing different exercise protocols: (i) submaximal exercise stress echocardiography (ESE) with LUS performed by expert cardiologists (N = 116, HFpEF = 65.5%), and (ii) maximal cycle ergometer test (CET) (N = 54, HFpEF = 50%) with LUS performed by unexperienced physicians shortly trained for the study. B-line kinetics (i.e. peak values and their changes from rest) were assessed.

Results

In the ESE cohort, the C-index (95% CI) of peak B-lines for HFpEF diagnosis was 0.985 (0.968–1.000), whereas the C-index of rest and exercise HFA-PEFF scores (i.e. including stress echo findings) were < 0.90 (CI 0.823–0.949), and that of H2FPEF score was < 0.70 (CI 0.558–0.764). The C-index increase of peak B-lines on top of the above-mentioned scores was significant (C-index increase > 0.090 and P-value < 0.001 for all). Similar results were observed for change B-lines. Peak B-lines > 5 (sensitivity = 93.4%, specificity = 97.5%) and change B-lines > 3 (sensitivity = 94.7%, specificity = 87.5%) were the best cutoffs for HFpEF diagnosis. Adding peak or change B-lines on top of HFpEF scores and BNP significantly improved diagnostic accuracy. Peak B-lines showed a good diagnostic accuracy in the LUS beginner-led CET cohort (C-index = 0.713, 0.588–0.838).

Conclusions

Exercise LUS showed excellent diagnostic value for HFpEF diagnosis regardless of different exercise protocols/level of expertise, with additive diagnostic accuracy on top of available scores and natriuretic peptides.

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Data availability

Data are available upon reasonable request to the principal investigators of the study.

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Author notes

  1. Stefano Coiro, Mathieu Echivard have contributed equally as first authors.

Authors and Affiliations

  1. Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy

    Stefano Coiro

  2. Université de Lorraine, INSERM, Centre d’Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France

    Stefano Coiro, Kevin Duarte, Masatake Kobayashi & Nicolas Girerd

  3. Département de Cardiologie, CHRU de Nancy, 54500, Vandœuvre-lès-Nancy, France

    Mathieu Echivard

  4. Institute for Treatment and Rehabilitation “Niska Banja”, Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia

    Dejan Simonovic & Marina Deljanin-Ilic

  5. Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal

    Mario Santos

  6. ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal

    Mario Santos

  7. Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy

    Giuseppe Ambrosio

  8. CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia School of Medicine, Perugia, Italy

    Giuseppe Ambrosio

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  1. Stefano Coiro
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Correspondence to Nicolas Girerd.

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Coiro, S., Echivard, M., Simonovic, D. et al. Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study. Clin Res Cardiol 112, 1129–1142 (2023). https://doi.org/10.1007/s00392-023-02219-y

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