Lung ultrasound predictive value in patients with acute heart failure

Pulmonary congestion is a common pathophysiological manifestation in patients with heart failure (HF). Lung ultrasound (LUS) is a relatively new method for assessing lung congestion.

Our goal was to assess the predictive value of LUS in patients with acute HF.

The study involved 194 patients in total. The LUS was performed on all patients. We used the 8-zone approach to perform LUS in patients with acute HF within 6 hours of admission. LUS detected lung congestion as B-lines, and the sum of the B-line from 8 chest zones was determined. The patients were divided into two groups depending on the amounts of B lines. Patients with a number of B-lines < 20 were included in Group 1 (98 patients) and patients with B-lines ≥ 20 were included in Group 2 (96 patients). The NT-proBNP analysis was performed both upon admission and 12 months later. The groups' other characteristics were similar. The primary outcome was NT-proBNP level over 12 months. The secondary endpoint was the rate of endotracheal intubation and in-hospital death.

NT-proBNP levels were, on average, 3572.6 ± 672.6pg/ml in group 1 and 3754.3 ± 853.6pg/ml in group 2 at the beginning of the study (p=0.1). It was 1324.5±521.4 pg/ml and 1654.7±623.7pg/ml, respectively, at the end of 12 months (p = 0.0004). In-hospital death was 2% (2 of 98 patients) in group 1 and 9.4% (9 of 96 patients) in group 2 (p =0.032), and the rate of endotracheal intubation was 4.1% (4 of 98 patients) and 12.5%(12 of 96 patients) respectively(p=0.04).

LUS may be used as part of the initial risk stratification in acute HF patients because it provides important prognostic information. The sum of B-lines detected by LUS can be an independent predictor of in-hospital complications and poor prognosis in patients with acute HF.