Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure.
OBJECTIVE
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.


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). Delta Sonographic score correlated with Delta 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.
Department of Emergency Medicine, San Luigi Gonzaga Hospital, 10043 Orbassano, Torino, Italy. gio.volpicelli@tin.it
Giovanni
G
Volpicelli
Valeria
V
Caramello
Luciano
L
Cardinale
Alessandro
A
Mussa
Fabrizio
F
Bar
Mauro F
MF
Frascisco
D000368:Aged; D000369:Aged, 80 and over; D015633:Extravascular Lung Water / Q000000981:diagnostic imaging*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000209:etiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014463:Ultrasonography
D020097:Natriuretic Peptide, Brain