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The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). BACKGROUND B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. METHODS The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n ¼ 1,012), vasodilator (n ¼ 1,054), or dobutamine (n ¼ 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, #2.0 for exercise and dobutamine, #1.1 for vasodilators); and abnormal coronary flow velocity reserve #2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) #1.80 for exercise and dobutamine (#1.22 for vasodilators). All patients completed follow-up. RESULTS According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n ¼ 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n ¼ 428; 20%); group III, moderate B-lines (score: 5 to 9; n ¼ 209; 9.7%) and group IV, severe B-lines (score: $10; n ¼ 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [