Utility of lung ultrasound in predicting pulmonary and cardiac pressures

Abstract

AimsQuantification of linear lung ultrasound (LUS) artefacts (B-lines) represents a novel, non-invasive approach to assess pulmonary congestion. We investigated the relationship between the number of B-lines (vertical artefacts arising from the pleural line) and intracardiac pressures. Methods and resultsPrior to scheduled right heart catheterization (RHC), 100 subjects underwent LUS of eight zones. A reviewer blinded to the haemodynamic data quantified the number of sonographic B-lines. Of 92 subjects who completed RHC, 79 had adequate LUS data of all zones [median age 61 years, 26 women, median left ventricular ejection fraction (LVEF) 58%, 35 with history of heart failure; 22 postcardiac transplantation]. The number of B-lines correlated with measured right atrial (r ¼ 0.32), pulmonary artery diastolic (PADP) (r ¼ 0.34), mean pulmonary artery (mPAP) (r ¼ 0.43), pulmonary artery systolic (PASP) (r ¼ 0.48) pressures, and pulmonary vascular resistance (PVR) (r ¼ 0.51) (P , 0.005 for all), but not with pulmonary capillary wedge pressure. There was a graded association between tertiles of B-line number and increasing PADP, mPAP, PASP, and PVR (P for trend ≤0.001 for all). Each additional B-line was associated with an increase in PASP of 1 mmHg and an increase in PVR of 0.1 Wood units. These associations remained robust after multivariable adjustment (P ¼ 0.002). Assessment of two inferior lateral zones resulted in similar correlations to the eight-zone method. ConclusionsEasily obtainable, LUS may be useful in the estimation of right-sided cardiac pressures and PVR. Further evaluation of lung ultrasound as an adjunct to heart failure diagnosis, monitoring, and prognosis is warranted.--

Echocardiographic and Lung Ultrasound Characteristics in Ambulatory Patients with Dyspnea or Prior Heart Failure

“…In 2013, in a sample of 20 MDs, with >5 years US practice and expertise (10 operators) or with 6 months of training in clinical US (10 operators), we asked them to assess twice the same movie clips of LUS with B-lines in 5 different clinical conditions; a fair intra-observer internal consistency is observed and the standard deviation is around 33.0% of the averages for each condition, considering the reports of all observers. Nonetheless, ranges of the B-lines individual counts are exceedingly wide for identical cases of each condition: pulmonary edema (3-10), chronic obstructive pulmonary disease exacerbation (4-10), pulmonary fibrosis (3-11), pleural effusion in congestive heart failure (HF) (3-10), pulmonary cancer lymphangitis (4)(5)(6)(7)(8)(9)(10). Which is the range for any measurement that the observers reported in the cases studied by Platz et al?…”

The efficacy of bedside chest ultrasound: from accuracy to outcomes

“…However, ultrasound does not accurately predict pulmonary artery occlusion pressure (PAOP) [82,87]. The absence of B-lines had a specificity of 95%, but a sensitivity of only 50% to predict PAOP ⩽18 mmHg [88].…”

Focused Ultrasound In The Emergency Department For Patients With Acute Heart Failure

“…15,27,28 In small studies, B-lines correlate well with natriuretic peptide levels 8 and wedge pressure, 28 though a more recent study shows only a modest correlation with filling pressures. 29 In addition, LUS evaluation of B-lines is non-invasive, facile, feasible and has high inter-rater agreement. 20,25 An alternative scanning protocol, counting the number of B-lines in 28 total rib spaces bilaterally, may allow for a more precise quantification of pulmonary oedema.…”