No abstract

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.

Aims Lung ultrasound (LUS) relies on detecting artefacts, including A-lines and B-lines, when assessing dyspnoeic patients. A-lines are horizontal artefacts and characterize normal lung, whereas multiple vertical B-lines are associated with increased lung density. We sought to assess the prevalence of A-lines and B-lines in patients with acute heart failure (AHF) and examine their clinical correlates and their relationship with outcomes. Methods and results In a prospective cohort study of adults with AHF, eight-zone LUS and echocardiography were performed early during the hospitalization and pre-discharge at an imaging depth of 18 cm. A- and B-lines were analysed separately off-line, blinded to clinical and outcome data. Of 164 patients [median age 71 years, 61% men, mean ejection fraction (EF) 40%], the sum of A-lines at baseline ranged from 0 to 19 and B-line number from 0 to 36. One hundred and fifty-six patients (95%) had co-existing A-lines and B-lines at baseline. Lower body mass index and lower chest wall thickness were associated with a higher number of A-lines (P trend < 0.001 for both). In contrast to B-lines, there was no significant change in the number of A-lines from baseline to discharge (median 6 vs. 5, P = 0.80). While B-lines were associated with 90-day HF readmission or death, A-lines were not [HR 1.67, 95% confidence interval (CI) 1.11–2.51 vs. HR 0.97, 95% CI 0.65–1.43]. Conclusions A-lines and B-lines on LUS co-exist in the vast majority of hospitalized patients with AHF. In contrast to B-lines, A-lines were not associated with adverse outcomes.