Bedside lung ultrasound in the evaluation of acute decompensated heart failure

Abstract

Dyspnea is a common presenting complaint in the emergency department (ED) and a leading cause of hospitalization in intensive care unit (ICU) and medical wards. Ultrasound (US) has traditionally been considered inadequate to explore the aerated lung. However, in the past 15 years LUS gained broader application, at least in part thanks to the interpretation of the artefacts generated by the interaction of US and lung structures/content. The total reflection of US beam occurring at the pleural level determines the artefactual image of the aerated lung: an homogenous 'foggy-like' picture under the pleural line. As the air content of the lungs decreases due to interstitial imbibition, deposition of collagen or presence of blood, vertical artefacts -arising from the pleural line and moving synchronously with the respiration- called B-lines appear. Multiple and bilateral B-lines identify the alveolar-interstitial syndrome (AIS). The most common cause of AIS is the wet lung: the more the congestion burden, the more the extent of the B-lines, which become confluent until the so-called white lung in case of pulmonary edema. Many studies showed a higher accuracy of LUS in diagnosing acute decompensated heart failure (ADHF) as compared to chest X-ray As recently shown, the integration of LUS to clinical assessment allow to differentiate cardiogenic dyspnea with sensitivity and specificity greater than 95 %. Moreover, LUS can easily detect pleural effusion -frequently present in ADHF-appearing as an anechoic area in the recumbent area of the thorax, delimited inferiorly by the diaphragmatic dome and superiorly by the aerated lung.

The application of lung ultrasound in acute decompensated heart failure in heart failure with preserved and reduced ejection fraction

“…Our study shows that B‐lines are positively correlated with E/eʹ and NT‐proBNP but negatively correlated with EF in the HFpEF and HFrEF groups. This correlation was not surprising because the presence of B‐lines implies more EVLW due to augmented LV filling pressure and is consistent with previous studies . The correlation coefficients were higher in the HFpEF group compared with those in the HFrEF group, which may suggest that B‐lines are more favorable for diagnosing HFpEF.…”

“…This correlation was not surprising because the presence of B-lines implies more EVLW due to augmented LV filling pressure and is consistent with previous studies. 9,25,26 The correlation coef-…”

Fifteen-minute consultation: Using point of care ultrasound to assess children with respiratory failure

“…As pulmonary oedema improves (eg, with diuretics or positive pressure ventilation), the number of B-lines reduces. POCUS can help show the resolution of pulmonary oedema in real time, unlike the chest radiograph, which tends to be slower 12. If you see multiple B-lines, maybe the child does not need volume resuscitation.…”

Lung ultrasound as a translational approach for non-invasive assessment of heart failure with reduced or preserved ejection fraction in mice

“…1 advances in the treatment of HF during the last decades, the prognosis for these patients 10 remains poor. In order to identify appropriate therapies appropriate preclinical testing in 11 animal models is needed.…”

“…Lung ultrasound 6 (LUS) has emerged in medicine as a readily available, highly reproducible and efficient 7 method for the assessment of pulmonary congestion. [8][9][10][11][12] LUS is especially useful to 8 determine pulmonary oedema and pleural effusion, which are common manifestations 9 of HF. 9,11,13 However, to our knowledge LUS has not been used to detect HF in mouse 10 models of cardiac disease.…”