Abstract 12380: Importance of Quantifying Lung Fluid Status in Patients With Heart Failure Using Chest Computed Tomography

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Background: Heart failure (HF) is a complex condition that requires accurate assessment for optimal management. B-type natriuretic peptide (BNP) has been widely used for diagnosis and monitoring, but its correlation with symptoms and prognosis can be inconsistent. This study investigates the utility of chest computed tomography (CT)-based evaluation of lung congestion as an additional tool in HF. Methods: CT imaging (SOMATOM Force, Siemens Healthineers) was performed in 129 HF patients on admission. Concurrently, BNP levels were measured. For image analysis, mean lung density (MLD), an index of lung congestion obtained from imaging, was analyzed by image analysis software (Syngo. CT Pulmo 3D, Siemens Healthineers). MLD was converted to fluid content (FC) in percentage units according to the equation: FC [%] = (MLD + 1000) / 10. The correlation between CT findings, BNP levels, clinical data, and prognosis was analyzed. Results: The FC of HF patients were significantly higher than those of non-HF patients (30.2 ± 6.2% vs. 18.2 ± 4.1%, p < 0.01), and showed a weak correlation with BNP levels at admission (r = 0.205, p = 0.020). The subjects were divided into four groups based on FC values (median 30.2%) and BNP levels (median 617 pg/mL): S1 (<30.2, <617), 2 (≥30.2, <617), S3 (<30.2, ≥617), and S4 (≥30.2, ≥617). During the observation period of 7 to 38 months (mean 19.5 months), 38 out of 129 patients died. FC values were significantly higher in patients who were readmitted (32.2 ± 6.2% vs. 29.4 ± 6.1%, p = 0.024). Cardiovascular death and survival were compared between groups (Figure). Group S1 showed significantly better survival compared to the other groups. Higher mortality rates were observed in groups with the higher FC values, even in those with lower BNP levels. Conclusion: The present data suggest that the evaluation of the lung congestion level (FC value) using CT imaging on admission in HF patients is an additional indicator for accurate prognostic evaluation, in addition to BNP.

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