Abstract
Ultrasound lung comets (ULCs) are a nonionizing bedside approach to assess extravascular lung water. We evaluated a protocol for grading ULC score to estimate pulmonary congestion in heart failure patients and investigated clinical and echocardiographic correlates of the ULC score. Ninety-three patients with congestive heart failure, admitted to the emergency department, underwent pulmonary ultrasound and echocardiography. A ULC score was obtained by summing the ULC scores of 7 zones of anterolateral chest scans. The results of ULC score were compared with echocardiographic results, the New York Heart Association (NYHA) functional classification, radiologic score, and N-terminal pro-b-type natriuretic peptide (NT-proBNP). Positive linear correlations were found between the 7-zone ULC score and the following: E/e′, systolic pulmonary artery pressure, severity of mitral regurgitation, left ventricular global longitudinal strain, NYHA functional classification, radiologic score, and NT-proBNP. However, there was no significant correlation between ULC score and left ventricular ejection fraction, left ventricle diameter, left ventricular volume, or left atrial volume. A multivariate analysis identified the E/e′, systolic pulmonary artery pressure, and radiologic score as the only independent variables associated with ULC score increase. The simplified 7-zone ULC score is a rapid and noninvasive method to assess lung congestion. Diastolic rather than systolic performance may be the most important determinant of the degree of lung congestion in patients with heart failure.
Highlights
In patients with congestive heart failure or intravascular volume overload, redistribution of fluids within the lungs leads to pulmonary edema
A standard method to quantify the volume of extravascular lung water (EVLW) by lung ultrasound has not been established, since there is no defined method for grading the severity of signs that are typical on lung ultrasound
This comprehensive scoring method is inconvenient in daily clinical practice, and counting B-lines in heart failure patients with lung congestion is confusing because Blines often merge
Summary
In patients with congestive heart failure or intravascular volume overload, redistribution of fluids within the lungs leads to pulmonary edema. The 28-sector approach has been applied to partially quantify lung congestion and showed positive linear correlation with the radiologic lung water score [6,7,8,9]. This comprehensive scoring method is inconvenient in daily clinical practice, and counting B-lines ( known as ultrasound lung comets or ULCs) in heart failure patients with lung congestion is confusing because Blines often merge.
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