Lung ultrasound and biomarkers in primary care: Partners for a better management of patients with heart failure?
Introduction: The association of pulmonary congestion assessed by lung ultrasound (LUS) and biomarkers—other than N-terminal pro-brain natriuretic peptide (NT-proBNP)—is uncertain.
Methods: We investigated the relationship between total B-line count by LUS and several biomarkers in outpatients with suspicion of heart failure (HF). Primary care patients with suspected new-onset nonacute HF were evaluated both with a 12-scan LUS protocol (8 anterolateral areas plus 4 lower posterior thoracic areas) and 11 inflammatory and cardiovascular biomarkers. A cardiologist blinded to LUS and biomarkers except NT-proBNP confirmed HF diagnosis. After log-transformation of biomarkers’ concentrations, unadjusted and adjusted correlations were performed.
Results: A total of 170 patients were included (age 76 ± 10 years, 67.6% women). HF diagnosis was confirmed in 38 (22.4%) patients. After adjustment by age, sex, body mass index, and renal function, total B-line sum significantly correlated with NT-proBNP (R = 0.29, p < 0.001), growth/differentiation factor-15 (GDF-15; R = 0.23, p = 0.003), high-sensitive Troponin T (hsTnT; R = 0.36, p < 0.001), soluble interleukin-1 receptor-like 1 (sST2; R = 0.29, p < 0.001), cancer antigen 125 (CA-125; R = 0.17, p = 0.03), high-sensitivity C-reactive protein (hsCRP; R = 0.20, p = 0.009), and interleukin (IL)-6 (R = 0.23, p = 0.003). In contrast, IL-33 (R = −0.01, p = 0.93), IL-1β (R = −0.10, p = 0.20), soluble neprilysin (sNEP; R = 0.09, p = 0.24), tumor necrosis factor-alpha (TNF-α; R = 0.07, p = 0.39), and TNF-α receptor superfamily member 1A (TNFRSF1A; R = 0.14, p = 0.07) did not.
Conclusions: Total B-line sum correlated significantly, although moderately, with congestion and several inflammation biomarkers. Unexpectedly, the highest correlation found was with hsTnT.
Platz E, Jhund PS, Campbell RT, McMurray JJ. Assessment and prevalence of pulmonary oedema in contemporary acute heart failure trials: a systematic review. Eur J Heart Fail. 2015;17:906-916.
Berezin AE. Prognostication in different heart failure pheno-types: the role of circulating biomarkers. J Circ Biomark. 2016;5:6.
Conangla L, Domingo M, Lupón J, et al. Lung ultrasound for heart failure diagnosis in primary care. J Card Fail. 2020 Jun 6:S1071-9164(19)31822-6. doi: 10.1016/j.cardfail.2020.04.019. Online ahead of print.
Pascual-Figal DA, Bayes-Genis A, Asensio-Lopez MC, et al. The interleukin-1 axis and risk of death in patients with acutely decompensated heart failure. J Am Coll Cardiol. 2019;73:1016-1025.
Wollert KC, Kempf T, Wallentin L. Growth differentiation factor 15 as a biomarker in cardiovascular disease. Clin Chem. 2017;63:140-151.
Myhre PL, Claggett B, Ballantyne CM, et al. Association between circulating troponin concentrations, left ventricular systolic and diastolic functions, and incident heart failure in older adults. JAMA Cardiol. 2019;4:997-1006.
Núñez J, Bayés-Genís A, Revuelta-López E, et al. Clinical role of CA125 in worsening heart failure: a BIOSTAT-CHF study subanalysis. JACC Heart Fail. 2020;8:386-397.
Copyright (c) 2020 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors contributing to Journal of Circulating Biomarkers agree to publish their articles under the Creative Common Attribution Non Commercial 4.0 (CC-BY-NC 4.0) license, which allows third parties to re-use the work without permission as long as the work is properly referenced and the use is non-commercial.