Prognostic value of the inferior vena cava diameter, lung ultrasound, and the NT-proBNP level in patients with acute decompensated heart failure and obesity

Aim. To evaluate the clinical and prognostic value of the inferior vena cava (IVC) diameter, the sum of B-lines according to lung ultrasound (LUS), and the NT-proBNP level in patients with acute decompensated heart failure (ADHF) and obesity.

Materials and methods. A single-center, prospective study included 162 patients with ADHF (66% men, age 68 ± 12 years, left ventricular ejection fraction (LVEF) 44 (35; 54)%, median level of NT-proBNP 4,246 (1,741; 6,837) pg / ml). 27.8% of patients were overweight, 55% of patients had obesity. Upon admission, all patients underwent a standard clinical and laboratory examination, including lung ultrasound with the calculation of the sum of B-lines, IVC ultrasound, and determination of the NT-proBNP level.

Results. Obese patients had a smaller sum of B-lines according to lung ultrasound than overweight patients and those with normal weight [33 (21–51); 38 (27–54), and 42 (30–58), respectively; p = 0.002] and a lower level of

NT-proBNP [3,404 (1,630; 5,516); 4,458 (2,697; 5,969); 5,085 (2,871; 7,351) pg / ml, respectively, p = 0.013]. The

IVC diameter did not differ significantly depending on body mass index (BMI): with obesity – 2.3 (1.9–2.8) cm, with overweightness – 2.3 (1.9–2.8) cm, and with normal weight – 2.2 (1.8–2.4) mm, p = 0.324.

According to the multivariate Cox regression analysis, the sum of B-lines > 7 at discharge (hazard ratio (HR) 8.90, 95% confidence interval (CI) 2.03–38.30, p = 0.003) and IVC > 2.4 cm at admission (HR 5.42, 95% CI 1.04–28.13, p = 0.045) were independently associated with a higher risk of 12-month mortality from cardiovascular disease.

Conclusion. Therefore, lung ultrasound with B-line quantification and assessment of the IVC diameter may be useful in obese patients with ADHF to stratify the risk of 12-month mortality from cardiovascular disease.

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