title: Utility of lung ultrasound in predicting pulmonary and cardiac pressures.
abstract: OBJECTIVE
  Quantification 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.
  
  
  RESULTS
  Prior 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 = 0.32), pulmonary artery diastolic (PADP) (r = 0.34), mean pulmonary artery (mPAP) (r = 0.43), pulmonary artery systolic (PASP) (r = 0.48) pressures, and pulmonary vascular resistance (PVR) (r = 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 = 0.002). Assessment of two inferior lateral zones resulted in similar correlations to the eight-zone method.
  
  
  CONCLUSIONS
  Easily 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.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. eplatz@partners.org
authors.forename: Elke
authors.initials: E
authors.lastname: Platz
authors.forename: AnnMarie
authors.initials: A
authors.lastname: Lattanzi
authors.forename: Chioma
authors.initials: C
authors.lastname: Agbo
authors.forename: Madoka
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Frederic S
authors.initials: FS
authors.lastname: Resnic
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000473:pathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000473:pathology; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012372:ROC Curve; D013223:Statistics as Topic; D013318:Stroke Volume; D014463:Ultrasonography; D014655:Vascular Resistance / Q000502:physiology*; D016277:Ventricular Function, Left; D055815:Young Adult