Background: Chronic heart failure (HF) coexist with chronic obstructive pulmonary disease (COPD) in approximately 25% of patients and is associated with worse outcomes. Lung ultrasound (LUS) is a validated technique to diagnose pulmonary congestion by detecting vertical lung artifacts, B−lines. Pulmonary inflammation is also associated with B−lines, but little is known about LUS in patients with acute exacerbation of COPD (AECOPD). Aims: To assess the feasibility of LUS to detect concurrent acute HF in AECOPD and examine the associations between B−lines, clinical parameters during hospitalization and rehospitalizations and mortality. Methods & results: In a prospective cohort study 123 patients with AECOPD (age 75±9 years, 57 [46%] men) underwent 8−zone bedside LUS within 24h after admission. A positive LUS was defined by B−lines in ≥2 zones bilaterally. A cardiologist committee blinded for LUS adjudicated whether concurrent HF was present (n=48, 39%). The median number of B-lines was 8 (IQR 5−13) and 16 (13%) patients had positive LUS. Positive LUS was associated with infiltrates on CXR. The prevalence of positive LUS was similar with and without concurrent HF 8 (17%) vs 8 (13%), p=0.93, while the number of B−lines was higher in concurrent HF: median 10 (IQR 6−16) vs 7 (IQR 4−12) (p=0.016). The sensitivity and specificity for positive LUS to detect concurrent HF was 13.2% and 87.1%, respectively. Positive LUS was not associated with re-hospitalization and mortality: Adjusted HR 0.93 (0.49−1.75), p=0.81. Conclusions: LUS did not detect concurrent HF or predict risk in patients hospitalized with AECOPD.

Heart failure (HF) often coexists with chronic obstructive pulmonary disease (COPD) and is associated with worse outcomes. We aimed to assess the feasibility of detecting vertical artifacts (B-lines) on lung ultrasound (LUS) to identify concurrent HF in patients hospitalized with acute exacerbation of COPD (AECOPD). Second, we wanted to assess the association between B-lines and the risk of rehospitalization for AECOPD or death. Patients and Methods: In a prospective cohort study, 123 patients with AECOPD underwent 8-zone bedside LUS within 24h after admission. A positive LUS was defined by ≥3 B-lines in ≥2 zones bilaterally. The ability to detect concurrent HF (adjudicated by a cardiologist committee) and association with events were evaluated by logistic-and Cox regression models. Results: Forty-eight of 123 patients with AECOPD (age 75±9 years, 57[46%] men) had concurrent HF. Sixteen (13%) patients had positive LUS, and the prevalence of positive LUS was similar between patients with and without concurrent HF (8[17%] vs 8[11%], respectively, p=0.34). The number of B-lines was higher in concurrent HF: median 10(IQR 6-16) vs 7(IQR 5-12), p=0.03. The sensitivity and specificity for a positive LUS to detect concurrent HF were 17% and 89%, respectively. Positive LUS was not associated with rehospitalization and mortality: Adjusted HR: 0.93(0.49-1.75), p=0.81. Conclusion: LUS did not detect concurrent HF or predict risk in patients with AECOPD.