Lung Ultrasound for the Evaluation of Pulmonary Congestion in Outpatients

Miglioranza, Marcelo Haertel; Gargani, Luna; Sant’Anna, Roberto T.; Rover, Marciane Maria; Martins, Vítor Magnus; Mantovani, Augusto; Weber, Cristina Klein; Moraes, Maria Antonieta; Feldman, Carlos Jader; Kalil, Renato A. K.; Sicari, Rosa; Picaño, Eugenio; Leiria, Tiago Luiz Luz

doi:10.1016/j.jcmg.2013.08.004

Cited by 175 publications

(58 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This technique produces images defined as “B-lines” (also known as “lung comets”) by scanning with probes along the intercostal spaces9. These artifacts are well associated with natriuretic peptides and echocardiographic indices of left ventricular (LV) filling pressures10, and seem to be determined by the degree of systolic and diastolic dysfunction and functional status assessed by New York Heart Association (NYHA) class11. Furthermore, lung ultrasound was shown to have a prognostic value on admission in an acute setting1213; however, those studies were not specifically focused on HF patients.…”

mentioning

confidence: 99%

Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study

Coiro

Porot²,

Rossignol

et al. 2016

Sci Rep

View full text Add to dashboard Cite

Pulmonary congestion assessed at discharge by lung ultrasonography predicts poor prognosis in heart failure (HF) patients. We investigated the association of B-lines with indices of hemodynamic congestion [BNP, E/e’, pulmonary systolic arterial pressure (PAPs)] in HF patients, and their prognostic value overall and according to concomitant atrial fibrillation (AF), reduced (≤40%) ejection fraction (EF), and timing of quantification during hospitalisation for heart failure (HHF). In 110 HHF patients, B-lines were highly discriminative of BNP >400 pg/ml (AUC ≥ 0.80 for all), and moderately discriminative of PAPs >50 mmHg (AUC = 0.68, 0.56 to 0.80); conversely, B-lines poorly discriminated average E/e’ ≥ 15, except at discharge. B-line count significantly predicted mid-term recurrent HHF or death (overall and in subgroups), regardless of AF status, EF, and timing of quantification during HHF (all p for interaction >0.10). regardless, B-lines ≥30 at discharge were most predictive of outcome (HR = 7.11, 2.06–24.48; p = 0.002) while B-lines ≥45 early during HHF were most predictive of outcome (HR = 9.20, 1.82–46.61; p = 0.007). Lung ultrasound was able to identify patients with high BNP levels, but not with increased E/e’, also showing a prognostic role regardless of AF status, EF or timing of quantification; best B-line cut-off appears to vary according to the timing of quantification during hospitalization.

show abstract

mentioning

confidence: 99%

Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study

Coiro

Porot²,

Rossignol

et al. 2016

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Similarly radiologists use cardiomegaly and effusions to diagnose heart failure 3 22 Studies counting effusions and fewer B lines have met with mixed success, usually improving sensitivity but losing specificity 2 5 , 6 , 16 , 23 The same occurred in this retrospective analysis.…”

Section: Design Lus Protocols To Match Acuitymentioning

confidence: 66%

Lung ultrasound in heart failure: Lessons from re‐analysis of Lung Ultrasound 2011 database

Baker

Mitchell

Thompson

et al. 2015

Australas J Ultrason Med

View full text Add to dashboard Cite

Introduction: In the setting of patients presenting with shortness of breath to an Emergency Department a simple lung ultrasound protocol aimed at detecting pulmonary oedema has been shown to have diagnostic accuracy of 85%. This article reviews data from the original study, in an attempt to determine whether adjusting the protocol and/or interpretive criteria would improve results. Method: A large lung ultrasound project provided the dataset. Inter‐rater and intertest discrepancies were reviewed. Then original stored images and comments were retrospectively analysed using alternate interpretive criteria. Specific variations included changing the number of B‐lines required to define ‘wet lung’ and assessing other pleural line abnormalities. Where they had been acquired cardiac loops were reviewed in addition to the lung images. Results: The 204 original studies available were reviewed. Some disagreement could be attributed to inexperience and unclear definitions. Adjusting the number of B‐lines did not improve diagnostic accuracy. All positive scans, with numerous B‐lines were reviewed using more advanced diagnostic criteria (pleural line abnormalities) and the number of false positives was decreased. In cases where cardiac views were available, their inclusion was beneficial. Conclusion: A simple lung ultrasound protocol to assess for ‘wet lung’ in patients presenting to Emergency Departments provides diagnostic accuracy of around 85% in the hands of relative novices. More advanced interpretation of the same_ultrasound images, and the addition of cardiac views, is likely to further improve diagnostic accuracy.

show abstract

“…This discordance among clinical, radiological and hemodynamic results has implications for the management of patients with HF and could lead to inaccurate diagnoses and inadequate treatment (24). Echocardiography can also be used to noninvasively measure LV filling pressures (12); the ratio of the early diastolic mitral inflow velocity to the early diastolic velocity of the mitral annulus (E/e') is one of the most frequently used parameters for the assessment of LV pressures (13,14). Both natriuretic peptides and E/e' can be used to identify hemodynamic congestion in systolic and diastolic HF patients, a condition that precedes pulmonary congestion.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 28 chest sites were scanned, and the total number of B-lines was recorded by an independent investigator. A B-line number ≥15 was considered as the cut-off for SPC (13). …”

Section: Methodsmentioning

confidence: 99%

“…A recent study (13) of chronic HF outpatients demonstrated the reliability of this noninvasive method in identifying clinically silent pulmonary edema and predicting adverse outcomes (14). In HF, the amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) is a powerful neurohormonal predictor of prognosis and elevated left ventricular (LV) filling pressures, and higher levels are correlated with greater degrees of pulmonary congestion (15-17).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients

Weber¹,

Miglioranza²,

Moraes³

et al. 2014

Clinics

View full text Add to dashboard Cite

OBJECTIVES:Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients.METHODS:We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) level >1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes.RESULTS:We included 58 patients (65.5% male, age 43.5±11 years) with a mean left ventricular ejection fraction of 27±6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale) was significantly correlated with a higher number of B-lines (p = 0.016). Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017).CONCLUSION:In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified.

show abstract

Lung Ultrasound for the Evaluation of Pulmonary Congestion in Outpatients

Abstract: In an HF outpatient clinic, B-lines were significantly correlated with more established parameters of decompensation. A B-line ≥15 cutoff could be considered for a quick and reliable assessment of decompensation in outpatients with HF.

Cited by 175 publications

References 48 publications

Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study

Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study

Lung ultrasound in heart failure: Lessons from re‐analysis of Lung Ultrasound 2011 database

The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients

Contact Info

Product

Resources

About