Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure☆

Abstract 

Purposes

Multiple artifacts B lines (B+) at transthoracic lung ultrasound have been proposed as a sonographic sign of pulmonary congestion. Our aim is to assess B+ clearance after medical treatment in acute decompensated heart failure (ADHF) and to compare the usefulness of sonography with other traditional tools in monitoring resolution of pulmonary congestion.

Methods

Eighty-one patients with a diagnosis of ADHF were submitted to lung ultrasound and chest radiography at admission, and 70 of them underwent the same procedures as control group after 4.2 ± 1.7 days of medical treatment. The ultrasound examination was performed with 11 scans on as many anterolateral thoracic areas (6 on the right side and 5 on the left side). Then, we calculated a sonographic score counting the B+ scans and compared it with radiologic score for extravascular lung water, clinical, and plasma brain natriuretic peptide improvement.

Main Results

All patients showed B+ pattern at admission and significant clearing after treatment, with median number of 8 positive scans (range, 3-9 scans) vs 0 (range, 0-7 scans) (P < .05). Our sonographic score showed positive linear correlation with radiologic score (r = 0.62; P < .05), clinical score (r = 0.87; P < .01), and brain natriuretic peptide levels (r = 0.44; P < .05). Δ Sonographic score correlated with Δ clinical (r = 0.55; P < .05) and radiologic (r = 0.28; P < .05) scores.

Conclusions

B line pattern mostly clears after adequate medical treatment of ADHF and represents an easy-to-use alternative bedside diagnostic tool for clinically monitoring pulmonary congestion in patients with ADHF.