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Ultrasound indices of congestion in patients with acute heart failure according to body mass index

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Abstract

Background

The inverse relationship between body mass index (BMI) and natriuretic peptide levels complicates the diagnosis of heart failure (HF) in obese patients. Assessment of congestion with ultrasound could facilitate HF diagnosis but it is unclear if any relationship exists amongst BMI, inferior vena cava (IVC) diameter and the number of B-lines.

Methods

We performed a comprehensive echocardiographic evaluation within 24 h from hospital admission in patients with HF, including lung B-lines and IVC diameter, and studied their relationship with BMI and outcome.

Results

216 patients (median age 81 (77–86) years) were enrolled. Median number of B-lines was 31 (IQR 26–38), median IVC diameter was 23 (22–25) mm and median BNP 991 (727–1601) pg/mL. BMI was inversely correlated with B-lines (r = − 0.50, p < 0.001), but not with IVC diameter (r = − 0.04, p = 0.58). Compared to overweight patients (BMI 25–29.9 kg/m2; n = 100) or with a normal BMI (BMI < 25 kg/m2; n = 59), obese patients (BMI ≥ 30 kg/m2; n = 57) had lower B-lines [28 (24–33) vs 30 (26–35), and vs 38 (32–42), respectively; p < 0.001] but similar IVC diameter. During the first 60 days of follow-up, there were 53 primary events: 29 patients died and 24 had a HF-related hospitalisation. B-lines and IVC diameter were independently associated with an increased risk. However, B-lines were less likely to predict outcome in the subgroup of patients with a BMI ≥ 30 kg/m2.

Conclusions

Assessment of IVC diameter or B-lines in patients admitted with AHF identifies those at greater risk of death or HF readmission. However, assessment of B-lines might be influenced by BMI.

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Data availability

Data available on request.

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Funding

This research did not receive specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy

    Alberto Palazzuoli, Gaetano Ruocco, Beatrice Franci, Isabella Evangelista, Barbara Lucani & Ranuccio Nuti

  2. Division of Cardiology, Regina Montis Regalis Hospital, Mondovì, Cuneo, Italy

    Gaetano Ruocco

  3. Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK

    Pierpaolo Pellicori

Authors
  1. Alberto Palazzuoli
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  2. Gaetano Ruocco
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  3. Beatrice Franci
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  4. Isabella Evangelista
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  5. Barbara Lucani
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  6. Ranuccio Nuti
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  7. Pierpaolo Pellicori
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Contributions

AP, GR and PP designed the study, interpreted data and drafted the manuscript; AP, GR, BF, IE, BL and RN collected and interpreted the data. GR analysed the data. All authors critically revised and approved the final version of the manuscript.

Corresponding author

Correspondence to Alberto Palazzuoli.

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The authors declare that there is no conflict of interest.

Ethics approval

The local ethical committee (C.E.A.V.S.E.) approved the study.

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All patients gave their written informed consent to participate to the study.

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The local ethical committee and all patients gave their written consent to publish the study.

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Palazzuoli, A., Ruocco, G., Franci, B. et al. Ultrasound indices of congestion in patients with acute heart failure according to body mass index. Clin Res Cardiol 109, 1423–1433 (2020). https://doi.org/10.1007/s00392-020-01642-9

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  • DOI: https://doi.org/10.1007/s00392-020-01642-9

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