AUTHOR=Li Yan , Ai Hu , Ma Na , Li Peng , Ren Junhong 

TITLE=Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.943633

DOI=10.3389/fcvm.2022.943633

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>The usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial.</p></sec><sec><title>Purpose</title><p>We aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF.</p></sec><sec><title>Materials and methods</title><p>We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) identified through systematic searches of MEDLINE, EMBASE, the Cochrane Database, Google Scholar, and SinoMed. The primary outcome was MACEs (a composite of all-cause mortality, HF-related rehospitalization, and symptomatic HF). The required information size was calculated by trial sequential analysis (TSA).</p></sec><sec><title>Results</title><p>In total, ten RCTs involving 1,203 patients were included. Overall, after a mean follow-up period of 4.7 months, LUS-guided treatment was associated with a significantly lower risk of MACEs than usual care [relative risk (RR), 0.59; 95% confidence interval (CI), 0.48–0.71]. Moreover, the rate of HF-related rehospitalization (RR, 0.63; 95% CI, 0.40–0.99) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration (standardized mean difference, –2.28; 95% CI, –4.34 to –0.22) were markedly lower in the LUS-guided treatment group. The meta-regression analysis showed a significant correlation between MACEs and the change in B-line count (<italic>p</italic> &lt; 0.05). The subgroup analysis revealed that the risk of MACEs was markedly lower in patients aged up to 70 years (RR, 0.54; 95% CI, 0.44–0.67), with a lower rate of atrial fibrillation (&lt; 27.2%) (RR, 0.53; 95% CI, 0.43–0.67), and with a lower NT-proBNP concentration (&lt; 3,433 pg/ml) (RR, 0.51; 95% CI, 0.40–0.64). TSA indicated a lower risk of MACEs with LUS-guided treatment than with usual care among patients with HF (<italic>p</italic> &lt; 0.05).</p></sec><sec><title>Conclusion</title><p>Lung ultrasound seems to be a safe and effective method to guide HF treatment.</p></sec><sec><title>Systematic review registration</title><p>[<ext-link ext-link-type="uri" xlink:href="https://inplasy.com/" xmlns:xlink="http://www.w3.org/1999/xlink">https://inplasy.com/</ext-link>], identifier [INPLASY202220124].</p></sec>