B‐lines by lung ultrasound predict heart failure in hospitalized patients with acute anterior wall STEMI

Abstract

Objective B‐line imaging by lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. The aim of this study was to explore the prognostic value of B‐line number at admission in predicting symptomatic heart failure (HF) during hospitalization in acute anterior wall STEMI patients. Methods This was a prospective cohort study which consecutively enrolled 96 anterior wall STEMI patients without dyspnea at admission. Pulmonary auscultation, NT‐proBNP test, LUS, and echocardiography were performed within 5 hours after primary PCI. Rale occurrence, plasma NT‐proBNP levels, B‐line number, LVEF, E/e’ were recorded, and their predictive value for HF in‐hospital was analyzed. Results A total of 19 patients developed symptomatic HF. Median B‐line number, NT‐proBNP levels, and E/e’ in the HF group were higher than those of the nonheart‐failure (NHF) group (P < 0.001) while LVEF was lower (P = 0.002). There was no statistical difference in rale occurrence between the two groups. Multivariate logistic regression demonstrated that B‐lines, E/e’, and NT‐proBNP independently predicted HF during hospitalization. According to the area under the ROC curve, the strongest predictor is B‐lines (0.972), followed by NT‐proBNP (0.936) and E/e’ (0.928), and combining the three indicators was better than any single parameter (P = 0.048). B‐line cutoff ≥18 could well predict HF event with specificity and sensitivity of 94.7% and 94.8%, respectively. Conclusion Subclinical pulmonary congestion reflected by B‐lines can independently predict symptomatic HF during hospitalization in patients with anterior wall STEMI, LUS will act as a complementary tool for evaluating cardiac function.

Prevalence and prognostic importance of lung ultrasound findings in acute coronary syndrome: A systematic review

“…The included studies were conducted between 2010 and 2021 in Argentina, Brazil, China, and Italy and included a total of 1199 patients with ACS. Three studies enrolled patients with STEMI, 10–12 one patients with STEMI or NSTEMI 13 and one patients with STEMI, NSTEMI, or unstable angina 14 . One publication included 112 (51%) of patients that were also included in another analysis by this study group that is included in this review 11,12 .…”

“…There were important differences in Killip class on admission ranging from one study including only patients without any signs of HF 13 and one study including up to 16% of patients with Killip class IV 12 . Only one study specifically excluded patients with relevant comorbidities like pulmonary infection or pulmonary fibrosis, which are known to be associated with B‐lines in the absence of HF 10 . A summary of the study characteristics and findings is presented in Tables 1 and 2.…”

“…Investigators used either phased array or curvilinear transducers for image acquisition. The number of LUS zones investigated was 28 zones in two studies 10,14 and eight zones in the three most recent publications 11–13 . None of the studies reported offline image analysis, that is, without blinding to clinical findings.…”

“…None of the studies reported offline image analysis, that is, without blinding to clinical findings. B‐line quantification was assessed by summing B‐lines of each zone to a total value in two studies 10,13 and by calculating a score in three studies 11,12,14 . Only one study reported the presence of pleural effusions which were present in two patients (2%) 10 .…”

Recommendations for Lung Ultrasound in Internal Medicine

“…Experts’ comments [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ,…”