Prognostic Value of Lung Ultrasound in Aortic Stenosis

Abstract

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.

Lung Sonography in Critical Care Medicine

“…This comet-tail artifact can be correlated to several clinical conditions, such as pulmonary edema, ARDS, chronic interstitial diseases, as well as focally with infectious or ischemic processes [ 30 , 57 , 58 , 59 ]. For aortic stenosis, it was shown that the number of B-lines correlates with the hemodynamic changes caused by the valve lesion and the functional status of the patient [ 60 ].…”

Haemodynamic and metabolic phenotyping of patients with aortic stenosis and preserved ejection fraction: A specific phenotype of heart failure with preserved ejection fraction?

“…Furthermore, compared to controls, ultrasound signs of pulmonary (B-lines) and systemic congestion (inferior vena cava [IVC] diameter and RVF pattern) are increased in ASpEF as much as in HFpEF. While it has already been shown that the number of B-lines and a dilated IVC correlate with deranged haemodynamics and increased risk of adverse events in AS, 33,34 this is the first study to comprehensively investigate multi-organ congestion in ASpEF. Such alterations also translate into ventilatory impairment, expressed by more severe ventilation-perfusion mismatch and ventilatory inefficiency.…”

Combining cardiopulmonary exercise testing with echocardiography: a multiparametric approach to the cardiovascular and cardiopulmonary systems

“…ESE can also highlight signs of dynamic increases in sPAP and pulmonary congestion (LUS B-lines) during the whole exercise, which carry an adverse prognostic significance in AS. 61 At the same time, CPET can indirectly assess SV response (VO 2 /work slope) and correlate echographic evidence of pulmonary congestion with data regarding ventilation/perfusion mismatch (VE/VCO 2 slope).…”