Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography

Abstract

The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). BACKGROUND B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. METHODS The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n ¼ 1,012), vasodilator (n ¼ 1,054), or dobutamine (n ¼ 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, #2.0 for exercise and dobutamine, #1.1 for vasodilators); and abnormal coronary flow velocity reserve #2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) #1.80 for exercise and dobutamine (#1.22 for vasodilators). All patients completed follow-up. RESULTS According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n ¼ 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n ¼ 428; 20%); group III, moderate B-lines (score: 5 to 9; n ¼ 209; 9.7%) and group IV, severe B-lines (score: $10; n ¼ 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [

Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography

“…Stress B-lines appear in one out of three patients without B-lines at rest [ 35 ]. More peak stress B-lines indicate a worse prognosis [ 35 , 36 , 37 ], and they can be found in all situations associated with dyspnea of cardiac origin [ 38 ], from CAD to diastolic dysfunction, from heart failure with reduced ejection fraction to heart failure with preserved ejection fraction [ 39 , 40 ], from aortic insufficiency to mitral stenosis [ 41 ] or extreme physiological settings such as trekking in high altitude [ 42 ] or apnea diving [ 43 ]. If there is water, there is a defect somewhere in the cardiovascular chain linking the alveolar capillary barrier to cardiovascular performance [ 44 ].…”

Association between lung ultrasound B‐lines and exercise‐induced pulmonary hypertension in patients with connective tissue disease

“…31 In this study, B-lines were measured in a simplified approach by scanning four intercostal spaces in the right hemithorax (right third and fourth spaces along the mid-axillary and midclavicular lines) because of the time constraints for imaging during the exercise. [32][33][34] The number of B-lines was assessed off-line in a single observer (T.I.) unaware of patients' information, and the total of B-lines in the four predefined zones was used for the primary analyses.…”

The effects of lockdown-induced air quality changes on the results of cardiac functional stress testing in coronary artery disease and heart failure patients

“…Step B included the assessment of B-lines with lung ultrasound. We adopted the 4-site simplified scan (Scali et al 2020). We analyzed the anterior and lateral hemithorax, scanning from midaxillary to mid-clavicular lines on the third intercostal space.…”

“…A total of 4 chest sites was scanned, and each site had a score from 0 to 10. The B criterion was considered positive in presence of stress B-lines ≥ 2 units (Scali et al 2020).…”