title: Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients.
abstract: OBJECTIVE
  Pulmonary congestion is a common and important finding in heart failure (HF). While clinical examination and chest radiography are insensitive, lung ultrasound (LUS) is a novel technique that may detect and quantify subclinical pulmonary congestion. We sought to independently relate LUS and clinical findings to 6-month HF hospitalizations and all-cause mortality (composite primary outcome).
  
  
  METHODS
  We used LUS to examine 195 NYHA class II-IV HF patients (median age 66, 61% men, 74% white, ejection fraction 34%) during routine cardiology outpatient visits. Lung ultrasound was performed in eight chest zones with a pocket ultrasound device (median exam duration 2 min) and analysed offline.
  
  
  RESULTS
  In 185 patients with adequate LUS images in all zones, the sum of B-lines (vertical lines on LUS) ranged from 0 to 13. B-lines, analysed by tertiles, were associated with clinical and laboratory markers of congestion. Thirty-two per cent of patients demonstrated ≥3 B-lines on LUS, yet 81% of these patients had no findings on auscultation. During the follow-up period, 50 patients (27%) were hospitalized for HF or died. Patients in the third tertile (≥3 B-lines) had a four-fold higher risk of the primary outcome (adjusted HR 4.08, 95% confidence interval, CI 1.95, 8.54; P < 0.001) compared with those in the first tertile and spent a significantly lower number of days alive and out of the hospital (125 days vs. 165 days; adjusted P < 0.001).
  
  
  CONCLUSIONS
  Pulmonary congestion assessed by ultrasound is prevalent in ambulatory patients with chronic HF, is associated with other features of clinical congestion, and identifies those who have worse prognosis.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA Harvard Medical School, Boston, USA eplatz@bwh.harvard.edu.
authors.forename: Elke
authors.initials: E
authors.lastname: Platz
authors.affiliation: Harvard Medical School, Boston, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, USA.
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.affiliation: Harvard Medical School, Boston, USA Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA.
authors.forename: Hajime
authors.initials: H
authors.lastname: Uno
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Julie
authors.initials: J
authors.lastname: Peck
authors.affiliation: Division of Emergency Medicine and High Dependency Unit, Cancer Epidemiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, Torino, Italy University of Turin, Turin, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pivetta
authors.affiliation: Department of Emergency Medicine and Cardiovascular Division, Brigham and Women's Hospital, Boston, USA.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Merz
authors.affiliation: Department of Cardiology, Angiology and Intensive Care, University Medical Center Mainz, Mainz, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Hempel
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA Harvard Medical School, Boston, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Frasure
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.affiliation: Harvard Medical School, Boston, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Harvard Medical School, Boston, USA Cardiovascular Division, Brigham and Women's Hospital, Boston, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging* / Q000401:mortality; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000503:physiopathology; D014463:Ultrasonography / Q000401:mortality
keywords: Heart failure; Lung ultrasound; Prognosis; Pulmonary congestion
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