Clinical Value Of Pulmonary Ultrasound B-line Score In Predicting The Prognosis Of Heart Failure After Myocardial Infarction

Objective:Heart failure(HF)is the severe and terminal stage of cardiovascular disease,and myocardial infarction(MI)is one of the most common and important causes of heart failure.Heart failure after myocardial infarction has an extremely high disability rate and mortality rate,and the prognosis of patients is poor.Therefore,how to evaluate the prognosis of patients with heart failure after myocardial infarction early and accurately is an urgent problem to be explored in clinical medicine.The purpose of this study is to explore the predictive value of the B-line score of pulmonary ultrasound for the prognosis of patients with heart failure after myocardial infarction.Methods:A retrospective cohort study design was used to collect and analyze the clinical data and survival data of 110 patients with heart failure after myocardial infarction treated in the Department of intensive Care Medicine(ICU)of a third-class hospital from January 2018 to January 2021.Using the receiver operating characteristic(ROC)curve to determine the ROC area under curve(AUC)and the best cut-off value of pulmonary ultrasound B-line score.And according to the best cut-off value,the subjects were divided into high score(B-line score of pulmonary ultrasound>22)and low score(B-line score of pulmonary ultrasound ≤22).The survival curve was drawn by Kaplan-Meier method,and the survival difference between high and low groups was tested by Log-Rank.In addition,Cox regression analysis was used to analyze the influencing factors of death and non-fatal myocardial infarction(NFMI)in patients with heart failure after myocardial infarction(NFMI),and the independent risk factors affecting the compound end point of heart failure after myocardial infarction were analyzed.Based on the pulmonary ultrasound B-line score of pulmonary ultrasound,combined with the other four independent risk factors,a Cox regression prediction model was established.ROC and AUC were used to evaluate the ability of the model to predict all-cause death or NFMI complex end point in patients with heart failure after myocardial infarction.Result:A total of 110 patients with heart failure after myocardial infarction were included in this study,including 56 cases in the low group(pulmonary ultrasound B-line score ≤22)and 54 cases in the high group(lung ultrasound B-line score>22).Using Log-Rank to test the survival difference between high and low groups,the cumulative mortality rate of high score group was significantly higher than that of low score group.Cox regression analysis was used for univariate and multivariate analysis.Univariate analysis showed that B-line score,LVEF,E-stroke,GCS,myocardial injury index,NT-proBNP,lactic acid clearance rate,white blood cell,serum albumin,serum creatinine,blood urea nitrogen and Killip grade were risk factors for all-cause death or NFMI complex end point of heart failure after myocardial infarction.Multivariate analysis further showed that B-line score,NT-proBNP,GCS,lactate clearance rate and Killip grade were independent risk factors for all-cause death or NFMI after myocardial infarction.In addition,based on the lung ultrasound B-line score and other four independent risk factors,the Cox regression model was used to construct the risk prediction model.The prediction model had a good differentiation by drawing the ROC curve(AUC=0.094,P ≤0.001).Through the goodness-of-fit test,Hosmer-Lemeshow χ 2-5.557 and 0.350>0.05 suggested that there was no significant difference between the model predicted value based on lung ultrasound score and the actual observation value.The prediction model has good calibration ability.Conclusion:The main results are as follows:(1)Pulmonary ultrasound B-line score>22 is an independent risk factor for all-cause death or NFMI in patients with heart failure after myocardial infarction.(2)the B-line score of pulmonary ultrasound is of good value in predicting the prognosis of patients with heart failure after myocardial infarction.(3)the prediction model based on lung ultrasound score has better differentiation and calibration ability.(4)Compared with the pulmonary ultrasound B-line score,the predictive model based on pulmonary ultrasound is more valuable in predicting all-cause death or NFMI complex end point in patients with heart failure after myocardial infarction.(5)Compared with the ROC curve of the lung ultrasound-based prediction model,B-line score and NT-proBNP,the prediction model has the highest sensitivity,the largest ROC curve area,and the largest predictive value.