Diagnostic accuracy of lung ultrasound for identification of elevated left ventricular filling pressure

Hubert, Arnaud; Girerd, Nicolas; Breton, Hervé; Galli, Elena; Latar, Ichraq; Fournet, Maxime; Mabo, Philippe; Schnell, Frédéric; Leclercq, Christophe; Donal, Erwan

doi:10.1016/j.ijcard.2019.01.055

Cited by 39 publications

(13 citation statements)

References 32 publications

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“…2 In addition, LUS has demonstrated substantial correlation with cardiac catheterization-derived LV end-diastolic pressure, making it a valuable adjunct to echocardiography and clinical variables in the management of heart failure patients. 19 Prognostic significance LUS-detected pulmonary congestion is associated with adverse outcomes even in asymptomatic patients. For instance, in a multi-center observational study including 392 ESKD patients on hemodialysis, those with very severe congestion (> 60 B-lines on a 28-zone scan) had a 4.2-fold risk of death (hazard ratio [HR] 4.20; 95% confidence interval, 2.45-7.23) and a 3.2-fold risk of cardiac events (HR 3.20; 95% CI,1.75-5.88) after adjusting for heart failure class and other risk factors compared with those having mild or no congestion (<15 B-lines).…”

Section: Diagnostic Performancementioning

confidence: 99%

Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

2021

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The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-Care Ultrasonography (POCUS) is emerging as a valuable non-invasive bedside diagnostic tool for objective evaluation of physiological and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function as well as quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography provides additional quantitative information including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function, pulmonary and venous congestion using POCUS and review relevant literature.

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Section: Diagnostic Performancementioning

confidence: 99%

Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

2021

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“…In this study, we used a simplified technique using eight scanning zones, similar to the study of Platz et al in ambulatory patients. 16 Previous studies have evaluated B-line cut-off between three and eight, 11,16 with three being used in eight zone techniques and eight in 28 zone techniques. The finding of 0.3 B-line or more per scanning site does appear as a reliable threshold to identify high-risk ambulatory HF patients.…”

Section: B-lines Evaluation: a Very Small Number But Still Providing ...mentioning

confidence: 99%

One year prognostic value of B‐lines in dyspnoeic patients

et al. 2021

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Aims Studies have demonstrated the reliability of B-lines evaluated by lung ultrasonography to identify pulmonary congestion, but information is lacking about its utility as a prognostic marker of heart failure (HF). We sought to assess the prognostic midterm value of B-lines in ambulatory patients presenting with dyspnoea, as an additive tool for patient management and to avoid acute HF exacerbations. Methods and results A total of 93 patients presenting with dyspnoea (New York Heart Association ≥2) were prospectively recruited in an outpatient clinic, and underwent clinical and echocardiographic evaluation, as well as B-line evaluation with lung ultrasonography in eight zones. Primary endpoint was HF hospitalization at 1 year. A total of 88 patients were included, age 72.3 ± 9.6, with left ventricular ejection 47.7 ± 28.6%; E/e' 16.9 ± 10.9, left atrial volume 51.9 ± 22.5 mL/m 2 ; peak tricuspid regurgitation velocity 2.6 ± 0.5 m/s, average B-line count 7.7 ± 10. 8 (9%) patients were hospitalized for HF, seven of which had ≥6 B-lines. B-line cut-off ≥6 (specificity = 66.2%; sensitivity = 87.5%) was predictive for HF hospitalization, with an odds ratio at 13.7 for HF hospitalization at 1 year [IC95% (1.6-117.4), P = 0.017]. Conclusions Ambulatory patients with ≥6 B-lines have a higher risk of HF hospitalization at 1 year. This study highlights the prognostic value of B-lines in evaluating HF risk in dyspnoeic patients.

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“…Hubert and colleagues performed direct measurements of LV filling pressure and B-lines assessment on patients with different cardiovascular conditions, undergoing coronary angiography, and found that the total number of B-lines was significantly higher in the elevated LVEDP group (≥20 mmHg). They underline that the diagnostic capacity of B-lines to identify elevated LVEDP is higher than that of classical echocardiographic strategies ( Hubert et al, 2019 ). Volpicelli et al also assessed B-lines in critically ill patients with simultaneous PCWP monitoring (with only 10 patients with cardiogenic pulmonary edema), confirming that B-lines allow good prediction of pulmonary congestion indicated by EVLW.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lung Ultrasound in Aortic Stenosis

et al. 2022

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Background: Aortic stenosis (AS) is the most common primary valve lesion requiring intervention in Europe and North America. It has a prolonged subclinical period during which, as AS worsens, left ventricular adaptation becomes inadequate and impaired systolic and/or diastolic dysfunction may lead to overt heart failure (HF). The development of HF is an inflexion point in the natural history of AS. Pulmonary congestion is a cardinal feature in HF, and lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, noninvasive tool to assess pulmonary congestion.Aim: To assess the presence and the prognostic value of sonographic pulmonary congestion in patients with moderate or severe AS.Methods: 75 consecutive patients (39 women, mean age 73.85 ± 7.7 years) with moderate or severe AS were enrolled. All patients underwent comprehensive echocardiography and LUS with the 28 scanning-site assessment. Patients were followed-up for 13.4 ± 6 months to establish the prognostic value of LUS. A composite endpoint of death (of any cause), hospitalization for HF and intensification of loop diuretic therapy was considered.Results: We found a severe degree of B-lines (≥30) in 29.33% of patients. The number of B-lines correlated with the estimated pulmonary artery systolic pressure (p < 0.001, r = 0.574) and increased along with NYHA class (p < 0.05, rho = 0.383). At multivariable analysis, B-lines ≥30, and mean gradient were the independent predictors of events [B-lines: 2.79 (CI 1.03–7.54), p = 0.04; mean gradient: 1.04 (CI 1.01–1.07), p = 0.004].Conclusion: Evaluation of B-lines is a simple, highly feasible method to detect pulmonary congestion in AS. The number of B-lines correlates with the hemodynamic changes caused by AS and with the functional status of patients. A severe degree of sonographic pulmonary congestion is associated with an increased risk of adverse events.

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Diagnostic accuracy of lung ultrasound for identification of elevated left ventricular filling pressure

Cited by 39 publications

References 32 publications

Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

One year prognostic value of B‐lines in dyspnoeic patients

Prognostic Value of Lung Ultrasound in Aortic Stenosis

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