Pulmonary Ultrasound in Patients with Heart Failure - Systematic Review

Abstract

Pulmonary congestion is an important clinical finding in patients with heart failure (HF). Physical examination and chest X-ray have limited accuracy in detecting congestion. Pulmonary ultrasound (PU) has been incorporated into clinical practice in the evaluation of pulmonary congestion. This paper aimed to perform a systematic review of the use of PU in patients with HF, in different scenarios. A search was performed in the MEDLINE and LILACS databases in February 2017 involving articles published between 2006 and 2016. We found 26 articles in the present review, 11 of which in the emergency setting and 7 in the outpatient setting, with diagnostic and prognosis defined value and poorly studied therapeutic value. PU increased accuracy by 90% as compared to physical examination and chest X-ray for the diagnosis of congestion, being more sensitive and precocious. The skill of the PU performer did not interfere with diagnostic accuracy. The presence of B-lines ≥ 15 correlated with high BNP values (≥ 500) and E/e' ratio ≥ 15, with prognostic impact in IC patients at hospital discharge and those followed up on an outpatient basis. In conclusion, when assessing pulmonary congestion in HF, PU has an incremental value in the diagnostic and prognostic approach in all scenarios studied.

Prognostic value of B lines detected with lung ultrasound in acute heart failure. A systematic review

“…A reduction of B lines with treatment showed a linear correlation with X‐ray results and NT‐proBNP levels ( p < 0.05). In their clinical practice, 25% of patients with a mean of 12.2 ± 7.3 B lines were readmitted at 90 days, while those with moderate pulmonary congestion were 100% readmitted 1 …”

The Role of Transthoracic Ultrasound in the Study of Interstitial Lung Diseases: High-Resolution Computed Tomography Versus Ultrasound Patterns: Our Preliminary Experience

“…The presence of more than three B-lines alone has never truly gained widespread scientific acceptance as a marker of “interstitial fibrosis” [ 21 , 31 ]. Indeed, in the literature, an increased number of B-lines has been described in several pathological conditions, ranging from lung fluid accumulation (i.e., heart failure [ 32 ] or end-stage renal disease accompanied by pulmonary congestion [ 33 ]), lung injury and/or inflammation (i.e., pulmonary contusion [ 34 ], acute respiratory distress syndrome [ 35 ], pneumonia [ 36 ], acute exacerbation of chronic obstructive pulmonary disease (COPD) [ 37 ], acute bronchial asthma [ 38 , 39 ], neoplastic lymphangitis [ 40 ]), to pulmonary fibrosis [ 9 , 10 , 12 ]. Moreover, no statistical significance has been attributed to B-line number in distinguishing between the ‘‘wet’’ lungs of patients affected by acute pulmonary edema and other primary pulmonary conditions [ 41 ].…”

Lung Ultrasound in the Diagnosis of COVID-19 Pneumonia: Not Always and Not Only What Is COVID-19 “Glitters”

“…Indeed, ultrasound findings in COVID-19 pneumonia are not specific. In fact, the most frequently advocated as typical COVID-19 LUS signs (i.e., a thickened and irregular pleural line with an increased number of B-lines) have been reported by literature in several pathological conditions, ranging from lung fluid accumulation [i.e., heart failure ( 33 ) or end-stage renal disease accompanied by pulmonary congestion ( 34 )], lung injury and/or inflammation [i.e., acute respiratory distress syndrome ( 35 ), other viral or bacterial pneumonia ( 36 ), pulmonary contusion ( 37 ), acute exacerbation of chronic obstructive pulmonary disease (COPD) and emphysema ( 38 ), acute bronchial asthma ( 39 , 40 ), neoplastic lymphangitis ( 41 )], till to interstitial remodeling [i.e,. bronchiectasis ( 42 ), pulmonary fibrosis ( 16 , 43 – 45 )].…”