Background: Lung ultrasound (LUS) is a bedside imaging tool that has proven useful in identifying and assessing the severity of pulmonary pathology. The aim of this study was to determine LUS patterns, their clinical significance, and how they compare to CT findings in hospitalized patients with coronavirus infection.Methods: This observational study included 62 patients (33 men, age 59.3±15.9 years), hospitalized with pneumonia due to COVID-19, who underwent chest CT and bedside LUS on the day of admission. The CT images were analyzed by chest radiographers who calculated a CT visual score based on the expansion and distribution of ground-glass opacities and consolidations. The LUS score was calculated according to the presence, distribution, and severity of anomalies.Results: All patients had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 8.1±2.9%. LUS identified 4 different abnormalities, with bilateral distribution (mean LUS score: 26.4±6.7), focal areas of non-confluent B lines, diffuse confluent B lines, small sub-pleural micro consolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (rho = 0.70; p<0.001). Correlation analysis of the CT and LUS severity scores showed good interclass correlation (ICC) (ICC =0.71; 95% confidence interval (CI): 0.52–0.83; p<0.001). Logistic regression was used to determine the cut-off value of ≥27 (area under the curve: 0.97; 95% CI: 90-99; sensitivity 88.5% and specificity 97%) of the LUS severity score that represented severe and critical pulmonary involvement on chest CT (CT: 3-4).Conclusion: When combined with clinical data, LUS can provide a potent diagnostic aid in patients with suspected COVID-19 pneumonia, reflecting CT findings.

Aim. To assess periprocedural dynamics of left ventricular ejection fraction (LVEF) in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) without heart failure (HF) in the medical history, as well as its prognostic value in the development of cardiovascular complications in the postinfarction period.Materials and methods. A prospective, single-center observational study included 131 patients with first AMI without HF in the past medical history and successful PCI. LVEF was assessed before PCI at admission and before discharge. In patients with reduced baseline LVEF of less than 50%, the criteria for its periprocedural improvement were chosen: 1) LVEF ≥ 50%; 2) ΔLVEF of more than 5%, but EF < 50%. The endpoints were hospitalization for the development of HF and death from cardiovascular disease in combination with the development of HF. The average follow-up period was 2.5 years.Results. At admission, LVEF was < 50% in 74 (56.5%) patients. At discharge, according to the criteria for LVEF improvement, the proportion of patients in this group was 40.5 and 14.9%, respectively. In 44.6% of cases, no increase in LVEF was noted. The predictors of the absence of periprocedural dynamics in LFEF included impaired regional contractility index > 1.94, left ventricular end-systolic volume > 57 ml, left ventricular end-diastolic diameter > 5.1 cm, pulmonary artery systolic pressure >27 mm Hg, NT-proBNP > 530 pg / ml, and E / A ratio > 1.06. During the follow-up period, 28 (21.4%) patients were hospitalized for the development of HF, 33 (25.2%) patients had a combined endpoint. The absence of periprocedural improvement in left ventricular contractility was independently associated with higher odds of hospitalization for HF (relative risk (RR) 3.5; 95% confidence interval (CI) 1.63–7.55; p = 0.001) and the combined endpoint (RR 2.6; 95% CI 1.28–5.48; p = 0.009) in the postinfarction period.Conclusion. In patients with first AMI and left ventricular systolic dysfunction, periprocedural evaluation of LVEF is reasonable to stratify the risk of adverse cardiovascular outcomes.

Aim. To evaluate the clinical and prognostic value of the inferior vena cava (IVC) diameter, the sum of B-lines according to lung ultrasound (LUS), and the NT-proBNP level in patients with acute decompensated heart failure (ADHF) and obesity.Materials and methods. A single-center, prospective study included 162 patients with ADHF (66% men, age 68 ± 12 years, left ventricular ejection fraction (LVEF) 44 (35; 54)%, median level of NT-proBNP 4,246 (1,741; 6,837) pg / ml). 27.8% of patients were overweight, 55% of patients had obesity. Upon admission, all patients underwent a standard clinical and laboratory examination, including lung ultrasound with the calculation of the sum of B-lines, IVC ultrasound, and determination of the NT-proBNP level.Results. Obese patients had a smaller sum of B-lines according to lung ultrasound than overweight patients and those with normal weight [33 (21–51); 38 (27–54), and 42 (30–58), respectively; p = 0.002] and a lower level ofNT-proBNP [3,404 (1,630; 5,516); 4,458 (2,697; 5,969); 5,085 (2,871; 7,351) pg / ml, respectively, p = 0.013]. TheIVC diameter did not differ significantly depending on body mass index (BMI): with obesity – 2.3 (1.9–2.8) cm, with overweightness – 2.3 (1.9–2.8) cm, and with normal weight – 2.2 (1.8–2.4) mm, p = 0.324.According to the multivariate Cox regression analysis, the sum of B-lines > 7 at discharge (hazard ratio (HR) 8.90, 95% confidence interval (CI) 2.03–38.30, p = 0.003) and IVC > 2.4 cm at admission (HR 5.42, 95% CI 1.04–28.13, p = 0.045) were independently associated with a higher risk of 12-month mortality from cardiovascular disease.Conclusion. Therefore, lung ultrasound with B-line quantification and assessment of the IVC diameter may be useful in obese patients with ADHF to stratify the risk of 12-month mortality from cardiovascular disease.

Aim. To assess the joint prognostic value of periprocedural dynamics of the left ventricular ejection fraction (PPD of LVEF) and subclinical pulmonary congestion during lung stress ultrasound in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in relation to the development of heart failure (HF) in the postinfarction period. Materials and methods. Our prospective, single-centre, observational study included 105 patients with a first MI with no HF in the anamnesis and successful PCI. All patients underwent standard clinical and laboratory tests, NT-proBNP level assessment, echocardiography, lung stress ultrasound with a 6-minute walk test. All patients had no clinical signs of heart failure at admission and at discharge. Criteria for PPD of LV EF: improvement in LV EF50%; ∆LV EF more than 5%, but LV EF50%. According to the results of lung stress ultrasound, pulmonary congestion was diagnosed: mild (24 B-lines), moderate (59 B-lines) and severe (10 B-lines). The end point was hospitalization for HF for 2.5 years. Results. Upon admission, LV EF of 50% or more was registered in 45 patients (42.9%). Positive PPD was registered in 31 (29.5%) patients. After stress ultrasound of the lungs, 20 (19%) patients had mild subclinical pulmonary congestion, 38 (36%) moderate and 47 (45%) severe according to the criteria presented. During the observation period, patients with no PPD of LVEF were significantly more likely to be hospitalized for the development of HF (in 44.4% of cases) compared with patients with positive PPD (in 15.2% of cases) and with initial LV EF50% (in 13.4% of cases; p=0.005). When performing logistic regression analysis, the best predictive ability was found in the combination of the absence of PPD of LV EF and the sum of B-lines 10 on exercise (relative risk 7.45; 95% confidence interval 2.5521.79; p0.000). Conclusion. Evaluation of the combination of PPD of LV EF and the results of stress lung ultrasound at discharge in patients with first AMI and successful PCI with no HF in anamnesis allows us to identify a high-risk group for the development of HF in the postinfarction period.