Longultrasongrafie onthult subklinische longcongestie bij stabiele HFpEF in de huisartspraktijk

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) accounts for a growing proportion of heart failure cases. Pulmonary congestion, particularly subclinical congestion, is often underestimated by symptoms and physical examination. Lung ultrasound enables detection of extravascular lung water through B-lines, even in early stages, but its role in HFpEF patients managed in primary care remains poorly defined. METHODS: This prospective, multisite observational study included ambulatory HFpEF patients with a prior hospitalization for heart failure decompensation and stable New York Heart Association class over the previous 3 months. Baseline evaluation included clinical assessment, biomarkers (N-terminal pro-brain natriuretic peptide, cancer antigen 125), frailty index, HF-related quality of life, 6-minute walking test, and bed-side lung ultrasound using a 28-zone protocol. Patients with pleural effusions were excluded, and B-lines were quantified offline. RESULTS: A total of 188 patients were analyzed (age 77.3 ± 9.9 years, 52.1% women, 46.9% obese, 81.9% New York Heart Association II, N-terminal pro-brain natriuretic peptide 974 pg/mL, 76% loop diuretic). Overall, 86.5% of patients showed at least one B-line, and one-third had ≥5 B-lines despite clinical stability. Higher B-line count was associated with higher systolic blood pressure, pulmonary crackles, and increased N-terminal pro-brain natriuretic peptide and cancer antigen 125 levels. In contrast, no significant relationship was found between B-lines and 6-minute walking test, frailty index, or HF-related quality of life. CONCLUSION: In stable ambulatory HFpEF patients managed in primary care, lung ultrasound frequently identifies subclinical pulmonary congestion. B-lines are associated with biomarkers of congestion, crackles, and systolic blood pressure, but not with functional capacity, frailty, or patient-reported health status.