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Considerations concerning ultrasound in residual congestion in decompensated heart failure
Consideraciones de la ecografía en la congestión residual en la insuficiencia cardíaca
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Gil Rodrigo, C. Martínez Buendía, V. Gil Espinosa, P. Herrero Puente" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Gil Rodrigo" "email" => array:1 [ 0 => "adri.gil.rodrigo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Martínez Buendía" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Gil Espinosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Herrero Puente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital General Universitario, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Quirónsalud, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Clínic, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Consideraciones de la ecografía en la congestión residual en la insuficiencia cardíaca" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the article by Pérez Calvo et al. titled “Residual congestion and clinical intuition in decompensated heart failure”<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> regarding the early detection of residual congestion in patients with heart failure (HF). Though the authors highlight the undeniable utility of ultrasound in HF diagnosis, particularly during decompensation, they state that there is no proof of its reliability to estimate congestion.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to point out that in “residual congestion”, in cases with relative clinical stability, the intuition mentioned in the article and the considerations of the survey respondents could result in suboptimal utility in terms of preventing decompensation due to its low sensitivity in subclinical stages. Despite the lack of standardised detection methods and adjustment of diuretic treatment, diagnostic tools do exist that complement and improve the profitability of clinical semiology and patient perception.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Lung ultrasound provides a semi-quantitative method via counting B-lines, achieving greater diagnostic performance than methods used until now, even in the aforementioned disease stages. Numerous publications report its prognostic utility, both in hospitalised patients and in outpatient services. It constitutes a short- to mid-term predictive indicator of complications following hospital discharge, enabling the significant association between the number of B-lines and post-discharge complications (hazard ratio at 60, 90 and 180 days of 3.30 [95% CI, 1.52–7.17; <span class="elsevierStyleItalic">p</span> = 0.002], 2.94 [95% CI, 1.46–5.93; <span class="elsevierStyleItalic">p</span> = 0.003] and 2.01 [95% CI, 1.11–3.64; <span class="elsevierStyleItalic">p</span> = 0.021], respectively<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Though protocols to integrate the technique have been put forward<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> and while we recognise the lack of standardisation of use in daily clinical practice, its diagnostic performance should not be questioned because of sufficient supporting scientific evidence.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gil-Rodrigo A, Martínez Buendía C, Gil Espinosa V, Herrero Puente P. Consideraciones de la ecografía en la congestión residual en la insuficiencia cardíaca. Rev Clin Esp. 2021;221:429–430.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La congestión residual y la intuición clínica en la insuficiencia cardiaca descompensada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.I. Pérez Calvo" 1 => "J. Rubio García" 2 => "C. Josa Laorden" 3 => "J.L. Morales Rull" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2019.02.004" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp." 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