Expert consensus document: Reporting checklist for quantification of pulmonary congestion by lung ultrasound in heart failure

Abstract

Lung ultrasound is a useful tool for the assessment of patients with both acute and chronic heart failure, but the use of different image acquisition methods, inconsistent reporting of the technique employed and variable quantification of 'B-lines,' have all made it difficult to compare published reports. We therefore need to ensure that future studies utilizing lung ultrasound in the assessment of heart failure adopt a standardized approach to reporting the quantification of pulmonary congestion. Strategies to improve patient care by use of lung ultrasound in the assessment of heart failure have been difficult to develop. In the present document, key aspects of standardization are discussed, including equipment used, number of chest zones assessed, the method of quantifying B-lines, the presence and timing of additional investigations (e.g. natriuretic peptides and echocardiography) and the impact of therapy. This consensus report includes a checklist to provide standardization in the preparation, review and analysis of manuscripts. This will serve as a guide for investigators and clinicians and enhance the quality and transparency of lung ultrasound research.

Lung Ultrasonography and Cardiac Surgery: A Narrative Review

“…38,39 This typically is evaluated using an 8-zone method (4 zones on each side), although a 28-zone method recently has become widespread. [40][41][42] The severity of pulmonary edema can be semiquantified by summing the amount of B-lines in the zones or by determining the number of affected zones. 42 When counting the B-lines in an isolated zone, a result of 3 to 5 lines is considered indicative of no fluid accumulation, 6 to 15 lines indicate minor edema, 16 to 30 lines indicate moderate edema, and >30 lines indicate severe edema.…”

“…[40][41][42] The severity of pulmonary edema can be semiquantified by summing the amount of B-lines in the zones or by determining the number of affected zones. 42 When counting the B-lines in an isolated zone, a result of 3 to 5 lines is considered indicative of no fluid accumulation, 6 to 15 lines indicate minor edema, 16 to 30 lines indicate moderate edema, and >30 lines indicate severe edema. 37,40,43 In addition, B-lines can merge to form wide bands that can progress to the "white lung" appearance (also known as LUS "ground glass") ( Fig 2).…”

“…However, the presence of pleural effusion and atelectasis can distort the ultrasonography findings and should be considered when interpreting congestion. 42 The diagnosis of pulmonary edema in the perioperative setting of cardiac surgery can require clearly differentiating between cardiogenic and noncardiogenic (postoperative acute respiratory distress syndrome) origins of interstitial syndrome. The size and inter-line spacing of B-lines may guide this differentiation as may the tissue Doppler and the "three-view" approaches (lungs, left ventricular ejection fraction, and inferior vena cava).…”

Response

“…Ensuring consistency and reproducibility of practice in these and other areas will be paramount to maintaining the credibility of POCUS as a diagnostic tool in this population, thereby avoiding the confusion and conflation of similar but differing concepts as its use becomes more widespread. 3 Indeed, a lack of standardized practice in the current POCUS evidence base has been recognized as a limitation to its wider acceptance and adoption as a diagnostic tool, 4 as is the failure to better define the technical aspects of image acquisition such as duration of recording, probe choice, and machine settings. 5 Allowing for and adapting to the default postimage processing and presets that are provided by modern ultrasound machines, and can alter the very artifacts we rely on for diagnostic LUS, requires a level of understanding that takes time to develop.…”

July 2019 at a glance: imaging of congestion, sodium–glucose co‐transporter 2 inhibitors, myocardial function and MitraClip trials

“…However, high variability in the methods used have made comparisons difficult between different studies and practical indications. The consensus document of the Study Group on Acute Heart Failure of the Acute Cardiovascular Care Association and the HFA of the European Society of Cardiology gives practical guidance with respect of the equipment to use, number of chest zones to assess, method of quantification of B‐lines, indications to additional investigations (e.g. BNP and echocardiography) and the impact on therapy.…”