Body mass index and B‐lines on lung ultrasonography in chronic and acute heart failure

Brainin, Philip; Claggett, Brian; Lewis, Eldrin F.; Dwyer, Kristin H.; Merz, Allison A.; Silverman, Montane B; Swamy, Varsha; Rivero, Jose; Cheng, Susan; McMurray, John J.V.; Solomon, Scott D.; Platz, Elke

doi:10.1002/ehf2.12640

Cited by 17 publications

(18 citation statements)

References 27 publications

(33 reference statements)

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“…The accuracy of lung POCUS may be impacted by patient factors. Elevated BMI reduced the sensitivity of lung POCUS for COVID-19, consistent with prior studies that have reported similar effects of obesity [ 33 ]. Pre-existing interstitial lung disease reduced the specificity of lung POCUS for COVID-19.…”

Section: Discussionsupporting

confidence: 89%

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

Brenner

Liu²,

Omron

et al. 2021

Ultrasound J

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Background As medical infrastructures are strained by SARS-CoV-2, rapid and accurate screening tools are essential. In portions of the world, reverse transcription polymerase chain reaction (RT-PCR) testing remains slow and in limited supply, and computed tomography is expensive, inefficient, and involves exposure to ionizing radiation. Multiple studies evaluating the efficiency of lung point-of-care ultrasound (POCUS) have been published recently, but include relatively small cohorts and often focus on characteristics associated with severe illness rather than screening efficacy. This study utilizes a retrospective cohort to evaluate the test characteristics (sensitivity, specificity, likelihood ratios, predictive values) of lung POCUS in the diagnosis of SARS-CoV-2, and to determine lung score cutoffs that maximize performance for use as a screening tool. Results Lung POCUS examinations had sensitivity 86%, specificity 71.6%, NPV 81.7%, and PPV 77.7%. The Lung Ultrasound Score had an area under the curve of 0.84 (95% CI 0.78, 0.90). When including only complete examinations visualizing 12 lung fields, lung POCUS had sensitivity 90.9% and specificity 75.6%, with NPV 87.2% and PPV 82.0% and an area under the curve of 0.89 (95% CI 0.83, 0.96). Lung POCUS was less accurate in patients with a history of interstitial lung disease, severe emphysema, and heart failure. Conclusions When applied in the appropriate patient population, lung POCUS is an inexpensive and reliable tool for rapid screening and diagnosis of SARS-CoV-2 in symptomatic patients with influenza-like illness. Adoption of lung POCUS screening for SARS-CoV-2 may identify patients who do not require additional testing and reduce the need for RT-PCR testing in resource-limited environments and during surge periods.

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Section: Discussionsupporting

confidence: 89%

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

Brenner

Liu²,

Omron

et al. 2021

Ultrasound J

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“…Our observation is different from the findings of Palazzuoli et al They found that in patients admitted to due to heart failure, the number of USBLs was lower in obese patients. An inverse correlation of USBLs and BMI was observed [33,34]. The interrelation between obesity and the severity of lung congestion deserves more attention.…”

Section: Discussionmentioning

confidence: 89%

Lung Congestion Severity in Kidney Transplant Recipients Is Not Affected by Arteriovenous Fistula Function

Letachowicz

Królicka

Tukiendorf

et al. 2022

JCM

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Lung ultrasound is a bedside technique for the assessment of pulmonary congestion. The study aims to assess the severity of lung congestion in kidney transplant recipients (KTR) in relation to arteriovenous fistula (AVF) patency. One hundred fifty-seven patients at least 12 months after kidney transplantation were recruited to participate in a cross-sectional study. Apart from routine visits, lung ultrasound at 28 typical points was performed. The patients were assigned to either AVF+ or AVF− groups. The mean number of lung ultrasound B-lines (USBLs) was 5.14 ± 4.96 with no differences between groups: 5.5 ± 5.0 in AVF+ and 4.8 ± 4.9 in AVF−, p = 0.35. The number and proportion of patients with no congestion (0–5 USBLs), mild congestion (6–15 USBLs), and moderate congestion (16–30 USBLs) were as follows: 101 (64.7%), 49 (31.4%), and 6 (3.8%), respectively. In multivariate analysis, only symptoms (OR 5.90; CI 2.43,14.3; p = 0.0001), body mass index (BMI) (OR 1.09; CI 1.03,1.17; p = 0.0046), and serum cholesterol level (OR 0.994; CI 0.998,1.000; p = 0.0452) contributed significantly to the severity of lung congestion. Lung ultrasound is a valuable tool for the evaluation of KTR. Functioning AVF in KTR is not the major factor affecting the severity of pulmonary congestion.

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“…B-lines are discrete count variables and we used unadjusted and adjusted negative binomial regression models (NBR) to explore associations between the total sum of B-lines and variables known to be associated with B-lines: Age, BMI, diuretics before LUS, congestion on CXR and infiltrate on CXR. [17][18][19][20][21] Results from the NBR models are reported as ratios with…”

Section: Discussionmentioning

confidence: 99%

“…B-lines are discrete count variables and we used unadjusted and adjusted negative binomial regression models (NBR) to explore associations between the total sum of B-lines and variables known to be associated with B-lines: Age, BMI, diuretics before LUS, congestion on CXR and infiltrate on CXR. 17-21 Results from the NBR models are reported as ratios with 95% confidence intervals (CI) and represent % increase or decrease in B-lines. Dynamic change in B-lines between consecutive LUS were assessed with the Wilcoxon signed rank test.…”

Section: Methodsmentioning

confidence: 99%

Lung ultrasound to assess pulmonary congestion in patients with acute exacerbation of COPD - a feasibility study

Johannessen

Reite

Bhatnagar

et al. 2022

Preprint

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Background: Chronic heart failure (HF) coexist with chronic obstructive pulmonary disease (COPD) in approximately 25% of patients and is associated with worse outcomes. Lung ultrasound (LUS) is a validated technique to diagnose pulmonary congestion by detecting vertical lung artifacts, B−lines. Pulmonary inflammation is also associated with B−lines, but little is known about LUS in patients with acute exacerbation of COPD (AECOPD). Aims: To assess the feasibility of LUS to detect concurrent acute HF in AECOPD and examine the associations between B−lines, clinical parameters during hospitalization and rehospitalizations and mortality. Methods & results: In a prospective cohort study 123 patients with AECOPD (age 75±9 years, 57 [46%] men) underwent 8−zone bedside LUS within 24h after admission. A positive LUS was defined by B−lines in ≥2 zones bilaterally. A cardiologist committee blinded for LUS adjudicated whether concurrent HF was present (n=48, 39%). The median number of B-lines was 8 (IQR 5−13) and 16 (13%) patients had positive LUS. Positive LUS was associated with infiltrates on CXR. The prevalence of positive LUS was similar with and without concurrent HF 8 (17%) vs 8 (13%), p=0.93, while the number of B−lines was higher in concurrent HF: median 10 (IQR 6−16) vs 7 (IQR 4−12) (p=0.016). The sensitivity and specificity for positive LUS to detect concurrent HF was 13.2% and 87.1%, respectively. Positive LUS was not associated with re-hospitalization and mortality: Adjusted HR 0.93 (0.49−1.75), p=0.81. Conclusions: LUS did not detect concurrent HF or predict risk in patients hospitalized with AECOPD.

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Body mass index and B‐lines on lung ultrasonography in chronic and acute heart failure

Cited by 17 publications

References 27 publications

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

Lung Congestion Severity in Kidney Transplant Recipients Is Not Affected by Arteriovenous Fistula Function

Lung ultrasound to assess pulmonary congestion in patients with acute exacerbation of COPD - a feasibility study

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