title: Echocardiographic and lung ultrasound characteristics in ambulatory patients with dyspnea or prior heart failure.
abstract: OBJECTIVE
  Lung ultrasound (LUS) represents a novel, noninvasive method in the assessment of extravascular lung water. We investigated the utility of LUS in ambulatory subjects with dyspnea or prior heart failure (HF).
  
  
  METHODS
  We studied 81 ambulatory subjects with HF history or dyspnea who underwent transthoracic echocardiography (TTE) with LUS of 8 zones. Subjects with heart transplantation or pulmonary conditions known to interfere with LUS were excluded. A reviewer blinded to the clinical data performed echocardiographic measurements and quantified B-lines (reverberation artifacts arising from the pleural line).
  
  
  RESULTS
  Of 81 subjects, 74 (91%) (median age 66 years, 39% men, median left ventricular ejection fraction [LVEF] 54%, 39% with prior HF) had adequate LUS images of all 8 zones and were included in the analysis. The number of B-lines ranged from 0-12 (median 2). Increased B-lines, analyzed by tertiles, were associated with larger left ventricular (LV) end-diastolic (P = 0.036) and end-systolic diameters (P = 0.026), septal wall thickness (P = 0.009), LV mass index (P = 0.001), left atrial (LA) volume index (P = 0.005), tricuspid regurgitation (TR) velocity (P = 0.005) and estimated pulmonary artery systolic pressure (PASP) (P = 0.003). In a secondary analysis associations between B-lines (not grouped by tertiles) and LV mass index, LA volume index, TR velocity and PASP remained stable after adjustment for age, gender, BMI and HF history.
  
  
  CONCLUSIONS
  Sonographic B-lines from LUS are related to measures of LV and LA structure and right ventricular pressure in ambulatory patients with dyspnea or prior HF. The added clinical and prognostic utility of this imaging modality in ambulatory patients warrants further investigation.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elke
authors.initials: E
authors.lastname: Platz
authors.forename: Dorothea
authors.initials: D
authors.lastname: Hempel
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pivetta
authors.forename: Jose
authors.initials: J
authors.lastname: Rivero
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D001794:Blood Pressure; D004417:Dyspnea / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D015633:Extravascular Lung Water / Q000000981:diagnostic imaging*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013318:Stroke Volume
keywords: dyspnea; echocardiography; heart failure; lung ultrasound