Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review

Abstract

Aims Pulmonary congestion is an important finding in patients with heart failure (HF) that can be quantified by lung ultrasound (LUS). We conducted a systematic review to describe dynamic changes in LUS findings of pulmonary congestion (B-lines) in HF and to examine the prognostic utility of B-lines in HF. Methods and results We searched online databases for studies conducted in patients with chronic or acute HF that used LUS to assess dynamic changes or the prognostic value of pulmonary congestion. We included studies in adult populations, published in English, and conducted in ≥25 patients. Of 1327 identified studies, 13 (25–290 patients) met the inclusion criteria: six reported on dynamic changes in LUS findings (438 patients) and seven on the prognostic value of B-lines in HF (953 patients). In acute HF, B-line number changed within as few as 3 h of HF treatment. In acute HF, ≥15 B-lines on 28-zone LUS at discharge identified patients at a more than five-fold risk for HF readmission or death. Similarly, in ambulatory patients with chronic HF, ≥3 B-lines on five- or eight-zone LUS marked those at a nearly four-fold risk for 6-month HF hospitalization or death. Conclusions Lung ultrasound findings change rapidly in response to HF therapy. This technique may represent a useful and non-invasive method to track dynamic changes in pulmonary congestion. Furthermore, residual congestion at the time of discharge in acute HF or in ambulatory patients with chronic HF may identify those at high risk for adverse events.

Evaluating pulmonary congestion with lung ultrasound and the need to take the next steps in heart failure

“…In this issue of the journal, Platz and colleagues describe a meta‐analysis assessing, firstly, temporal changes and, secondly, the prognostic value of B‐lines on LUS in HF . This meta‐analysis includes only 13 studies, half of which involved fewer than 100 subjects.…”

“…Lung ultrasonography (LUS) is a non‐invasive method of making a semi‐quantitative assessment of pulmonary congestion and more directly a measure of extravascular lung water content . In the ‘wet’ state, B‐lines (formerly known as ‘lung comets’ or ‘comet tails’) can be visualized by ultrasound, whereas, with a few exceptions, B‐lines are not detected in patients without pulmonary congestion (illustrative figures are available in papers by Picano and Pellikka and Platz et al …”

Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy

“…[21][22][23][24][25] Calculated PVS might be prognostic because it truly reflects fluid retention that could be a marker or mediator of CHF progression. Moreover, it did so after adjustment for treatment allocation implying that the associations elucidated here were not simply driven by FCM.…”

Highlights in heart failure

“…230 Clinical signs have a major role for the prognostic assessment and treatment selection in the patients with acute HF. 235,236 Inferior vena cava diameter and jugular venous distension are indexes of venous congestion and right ventricular filling pressure. A low blood pressure identifies the patient with low cardiac output and peripheral hypoperfusion, and these patients have the highest mortality during followup.…”