Comparison of lung bedside ultrasound and BNP in the diagnosis of acute heart failure in the emergency department

Introduction: Congestive heart failure is heart muscle failure that causes pulmonary congestion and eventually pulmonary edema, which despite recent medical advances, is still a progressive syndrome with high mortality, the prevalence of which has increased in recent decades. Therefore, in this study we compared lung ultrasound findings in acute heart failure patients with the BNP. Methods: This study was performed in the emergency room of Imam Reza hospital in Tabriz. For patients entering the emergency room after taking a history, both standard gold (BNP) tests and beside ultrasound of the lung were performed. Ultrasound was performed at the same time as obtaining blood sample to ensure that the ultrasound specialist did not know the result of diagnosis. During the ultrasound, if there were multiple B-Lines that were at least 3 mm apart, patient was diagnosed with pulmonary edema due to heart failure. Results: Number of participants in this study was 108 people, 54.6% of whom were men and the rest were women. The correlation coefficient between width and number of kerley lines was 0.79, between NT-pro BNP and width of kerley lines was 0.65 and between NT-pro BNP and number of kerley lines was 0.77, which indicates a significant positive correlation (P value <0.001). Conclusion: The results of present study showed that in patients with acute heart failure, the number and width of kerley lines in pulmonary ultrasound evaluation increase rapidly. There is also a high correlation between number and length of kerley lines with NT-pro BNP serum values.

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Lung Ultrasound Eight-Point Method in Diagnosing Acute Heart Failure in Emergency Patients with Acute Dyspnea: Diagnostic Accuracy and 72 h Monitoring

Medicina ◽

10.3390/medicina56080379 ◽

2020 ◽

Vol 56 (8) ◽

pp. 379

Author(s):

Erika Glöckner ◽

Felicitas Wening ◽

Michael Christ ◽

Alexander Dechêne ◽

Katrin Singler

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Rating Scale ◽

Lung Ultrasound ◽

Point Of Care ◽

Final Diagnosis ◽

Acute Dyspnea ◽

Ultrasound Evaluation ◽

B Lines

Background and Objectives: Acute dyspnea is a common chief complaint in the emergency department (ED), with acute heart failure (AHF) as a frequent underlying disease. Early diagnosis and rapid therapy are highly recommended by international guidelines. This study evaluates the accuracy of point-of-care B-line lung ultrasound in diagnosing AHF and monitoring the therapeutic success of heart failure patients. Materials and Methods: This is a prospective mono-center study in adult patients presenting with undifferentiated acute dyspnea to a German ED. An eight-zone pulmonary ultrasound was performed by experienced sonographers in the ED and 24 and 72 h after. Along with the lung ultrasound evaluation patients were asked to assess the severity of shortness of breath on a numeric rating scale. The treating ED physicians were asked to assess the probability of AHF as the underlying cause. Final diagnosis was adjudicated by two independent experts. Follow-up was done after 30 and 180 days. Results: In total, 102 patients were enrolled. Of them, 89 patients received lung ultrasound evaluation in the ED. The sensitivity of lung ultrasound evaluation in ED in diagnosing AHF was 54.2%, specificity 97.6%. As much as 96.3% of patients with a positive LUS test result for AHF in ED actually suffered from AHF. Excluding diuretically pretreated patients, sensitivity of LUS increased to 75% in ED. Differences in the sum of B-lines between admission time point, 24 and 72 h were not statistically significant. There were no statistically significant differences in the subjectively assessed severity of dyspnea between AHF patients and those with other causes of dyspnea. Of the 89 patients, 48 patients received the final adjudicated diagnosis of AHF. ED physicians assessed the probability of AHF in patients with a final diagnosis of AHF as 70%. Roughly a quarter (23.9%) of the overall cohort patients were rehospitalized within 30 days after admission, 38.6% within 180 days of follow-up. Conclusion: In conclusion, point-of-care lung ultrasound is a helpful tool for the early rule-in of acute heart failure in ED but only partially suitable for exclusion. Of note, the present study shows no significant changes in the number of B-lines after 24 and 72 h.

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Hot Off the Press: B-lines and Focused Lung Ultrasound to Diagnose Acute Heart Failure in Dyspneic Patients

Academic Emergency Medicine ◽

10.1111/acem.12751 ◽

2015 ◽

Vol 22 (9) ◽

pp. 1122-1124 ◽

Cited By ~ 2

Author(s):

Karalynn Otterness ◽

William K. Milne ◽

Christopher R. Carpenter

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

The Press ◽

B Lines

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Diagnostic and Prognostic Value of Lung Ultrasound B-Lines in Acute Heart Failure With Concomitant Pneumonia

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.693912 ◽

2021 ◽

Vol 8 ◽

Author(s):

Matteo Mazzola ◽

Nicola Riccardo Pugliese ◽

Martina Zavagli ◽

Nicolò De Biase ◽

Giulia Bandini ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Hospital Readmission ◽

Lung Ultrasound ◽

Adverse Outcome ◽

Prognostic Stratification ◽

The Difference ◽

B Lines ◽

Diagnostic And Prognostic Value

Purpose: To evaluate the potential confounding effect of concomitant pneumonia (PNM) on lung ultrasound (LUS) B-lines in acute heart failure (AHF).Methods: We enrolled 86 AHF patients with (31 pts, AHF/PNM) and without (55 pts, AHF) concomitant PNM. LUS B-lines were evaluated using a combined antero-lateral (AL) and posterior (POST) approach at admission (T0), after 24 h from T0 (T1), after 48 h from T0 (T2) and before discharge (T3). B-lines score was calculated at each time point on AL and POST chest, dividing the number of B-lines by the number of explorable scanning sites. The decongestion rate (DR) was calculated as the difference between the absolute B-lines number at discharge and admission, divided by the number of days of hospitalization. Patients were followed-up and hospital readmission for AHF was considered as adverse outcome.Results: At admission, AHF/PNM patients showed no difference in AL B-lines score compared with AHF patients [AHF/PNM: 2.00 (IQR: 1.44–2.94) vs. AHF: 1.65 (IQR: 0.50–2.66), p = 0.072], whereas POST B-lines score was higher [AHF/PNM: 3.76 (IQR: 2.70–4.77) vs. AHF = 2.44 (IQR: 1.20–3.60), p < 0.0001]. At discharge, AL B-lines score [HR: 1.907 (1.097–3.313), p = 0.022] and not POST B-lines score was found to predict adverse events (AHF rehospitalization) after a median follow-up of 96 days (IQR: 30–265) in the overall population.Conclusions: Assessing AL B-lines alone is adequate for diagnosis, pulmonary congestion (PC) monitoring and prognostic stratification in AHF patients, despite concomitant PNM.

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PREDISCHAGE LUNG ULTRASOUND AS A PREDICTOR OF REHOSPITALIZATION OR MORTALITY ACUTE HEART FAILURE PATIENTS

International journal of Research science and Management - September-2020 ◽

10.29121/ijrsm.v7.i8.2020.5 ◽

2020 ◽

Vol 7 (8) ◽

pp. 28-34

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

Independent Predictor ◽

Hypertensive Heart Disease ◽

Functional Class ◽

Pulmonary Congestion ◽

Class Iii ◽

B Lines

Backgroud: Persistent congestion is a major cause of rehospitalization in patients with acute heart failure (AHF). Lung Ultrasound (LUS) is an easy and valid examination in assessing pulmonary congestion. The number of B-lines correlates very strongly with the amount of extravascular lung fluid (EVLW). The aim of this study is to determine if LUS pre-discharge can predict rehospitalization or mortality. Methods: This single centered cohort study included 127 consecutive AHF patients. LUS on 28 antorolateral chest wall segment was done double blindly before discharging the patient to calculate the B-line. Clinical data, Composite Congestion Score (CCS) and echocardiography were collected. Cox proportional hazard regression analysis was performed to assess the independent predictor of rehabilitation or mortality during 120 days of observation. Results: The patients were 57.4 ± 7.8 years old, most were male (66.9%), with LV EF 36.7 ± 7.2%. The etiology of heart failure was caused by coronary heart disease (56.7%) and hypertensive heart disease (40.9%). The median number of B-lines was 24 (15 - 39). Hospitalization or death occurred in 43 patients (33.8%) during the median observation of 120 days (73-120). Patients with B-line pre-discharge ≥30 had a lower mean survival (log rank X2 48.14; p <0.001). In multivariate analysis, B-line pre-discharge ≥30 was the strongest independent predictor of rehabilitation or mortality (HR 4.71; 95% CI 2.15 - 10.32). Other independent predictors are Composite Congestion Score (CCS) ≥ 3 (HR 4.26; 95% CI 2.07 - 8.77) and NYHA functional class III (HR 2.87; 95% CI 1.49 - 5, 53). Conclusion: Persistent pulmonary congestion in AHF patients as assessed by B-line pre-discharge ≥30 is a strong independent predictor of rehospitalization or mortality. LUS could potentially help to guide the timing of discharge from AHF hospitalization, the follow-up scheduling and the therapy tailoring. Further randomized clinical studies are needed to definitely support the routine use of LUS.

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The Value of a Simplified Lung Ultrasound Protocol in the Pre-Discharge Evaluation of Patients Hospitalized with Acute Heart Failure

Acta Medica Marisiensis ◽

10.1515/amma-2016-0039 ◽

2016 ◽

Vol 62 (3) ◽

pp. 318-320

Author(s):

Frigy Attila ◽

Kocsis Ildikó ◽

Fehérvári Lajos ◽

Szabó István Adorján

Keyword(s):

Heart Failure ◽

Hospital Discharge ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

Clinical Status ◽

Optimal Timing ◽

Exact Test ◽

Us Findings ◽

The Right ◽

B Lines

AbstractOptimal timing of hospital discharge in patient with acute heart failure (AHF) is an important factor of preventing rehospitalizations.Aim. To evaluate the value of a simplified lung ultrasound (LUS) protocol in assessing pre-discharge status of patients with AHF, correlating the US findings with the values of NT-proBNP levels.Methods. 24 patients (18 men, 6 women, mean age 68,2 years) hospitalized with acute heart failure underwent LUS examination in the afternoon of the day before hospital discharge, applying a simplified LUS protocol, using three basal examination areas on the right side (anterior, lateral and posterior) and two basal examination areas on the left side (lateral and posterior). The LUS score was represented by the sum of B lines. In the next morning the value of NT-proBNP was also determined. The correlation between LUS findings and NT-proBNP values was analyzed using Fisher's exact test (significant if alpha<0,05).Results. 6 patients had <15 B lines, 16 patients had >15 B lines and 2 patients had pleural effusion on LUS, while 16 patients had the value of NT-proBNP >1000pg/ml at discharge. The results of LUS examination correlated significantly (p=0.0013) with the NT-proBNP values – only one patient not having increased NT-proBNP in the group with >15 B lines.Conclusions. Despite a relatively good clinical status, the majority of patients had high NT-proBNP values at the time of hospital discharge. LUS proved to be a useful tool in identifying patients with subclinical congestion reflected also by the high NT-proBNP levels. These patients may need a prolongation of hospitalization and/or a more careful follow-up to prevent early readmission.

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Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial

Heart & Lung ◽

10.1016/j.hrtlng.2018.10.027 ◽

2019 ◽

Vol 48 (3) ◽

pp. 186-192 ◽

Cited By ~ 5

Author(s):

Frances M. Russell ◽

Robert R. Ehrman ◽

Robinson Ferre ◽

Luna Gargani ◽

Vicki Noble ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

Pilot Trial ◽

Ultrasound Guided ◽

Emergency Department Management ◽

B Lines ◽

Department Management

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Quantification of pleural effusions on thoracic ultrasound in acute heart failure

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620901835 ◽

2020 ◽

Vol 9 (5) ◽

pp. 513-521

Author(s):

Moritz Lindner ◽

Richard Thomas ◽

Brian Claggett ◽

Eldrin F Lewis ◽

John Groarke ◽

...

Keyword(s):

Heart Failure ◽

Pleural Effusion ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Pleural Effusions ◽

Ventricular Ejection Fraction ◽

Thoracic Ultrasound ◽

B Lines

Background: Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically. Methods: In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size. Results: Among 188 patients (median age 72 years, 62% men, 78% white, median left ventricular ejection fraction 38%), pleural effusions on thoracic ultrasound 1 were present in 66% of patients and decreased in size during the hospitalisation in 75% based on the pleural effusion score ( P<0.0001). Higher values of the pleural effusion score were associated with higher pleural effusion volumes on computed tomography ( P<0.001), higher NT-pro brain natriuretic peptide values ( P=0.001) and a greater number of B-lines on lung ultrasound ( P=0.004). Nevertheless, 47% of patients were discharged with persistent pleural effusions, 19% with large effusions. However, higher values of the pleural effusion score on thoracic ultrasound 2 did not identify patients at increased risk of 90-day heart failure rehospitalisations or death (adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92–1.19; P=0.46) whereas seven or more B-lines on lung ultrasound at discharge were independently associated with adverse events (adjusted HR 2.43, 95% CI 1.11–5.37; P=0.027). Conclusion: Among patients with acute heart failure, pleural effusions are associated with other clinical, imaging and laboratory markers of congestion and improve with heart failure therapy. The prognostic relevance of persistent pleural effusions at discharge should be investigated in larger studies.

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P1655Lung ultrasound B-lines in patients with acute heart failure and comorbidities

European Heart Journal ◽

10.1093/eurheartj/ehz748.0413 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Gargani ◽

M Zavagli ◽

G Barbarisi ◽

C Marchiani ◽

G Bandini ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

High Variability ◽

Chronic Obstructive ◽

Pulmonary Congestion ◽

Lung Water ◽

Obstructive Pulmonary Disease ◽

Time Points ◽

B Lines

Abstract Background Lung ultrasound assessment of B-lines is a sonographic method for a semi-quantitative evaluation of extravascular lung water, that can be employed to asssess and monitor pulmonary congestion in acute heart failure. Purpose To assess the degree and changes in B-lines during hospitalization for acute heart failure, independently of the etiology, and their correlation with patients' comorbidities. Methods Two-hundred and forty-one complete antero-lateral B-lines assessments were recorded in an old population of 73 patients (mean age 83.0±7.6 years, 54.8% males) admitted with a diagnosis of acute heart failure (AHF). Chronic obstructive pulmonary disease (COPD) was present in 30% patients, chronic kidney disease (CKD) was present in 31% patients, a previously known cardiac condition was present in 73% of patients. B-lines were evaluated according to standard protocol at admission (T1), at 24 hours (T2), 48 hours (T3) and at discharge (T4). NT-proBNP was assessed at admission and at discharge. Results Mean antero-lateral B-lines at T1 were 42±39 with a statistically significant reduction at T3 (25±23, p<0.001) and at T4 (16±22, p<0.001), but not at T2 (37±38, p=0.41) (see figure), with high variability in the percentage of B-lines reduction among patients, at all time points, and with 34% of patients with still significant pulmonary congestion at discharge (≥15 B-lines). B-lines number and changes did not differ in patients with and without COPD, CKD, or a previously known heart/valvular disease. A weak, albeit significant correlation was found between the percentage of B-lines change between admission and discharge and total diuresis (R=-0.25, p<0.05), delta (T3 values - T1 values) glomerular filtration rate (R=0.30, p<0.05) and delta NT-proBNP (R=0.31, p<0.05). Dynamic changes of B-lines over time Conclusions In older patients hospitalized with AHF with multiple comorbidities, B-lines are present at admission and significantly reduce at 48 hours, although with high variability among different patients at all time points, and persistent significant congestion at discharge in about one third of patients. Lung ultrasound B-lines provide a specific and dynamic information about the degree and changes of pulmonary congestion, which is additive to other patient's characteristics.

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