Lung Comet tail artefact in diagnosis and monitoring of pulmonary congestion in patients with sistolic and diastolic Heart Failure

Abstract

The aim of this study was to evaluate the importance of thoracic ultrasound examination in diagnosis of DHF. Total of 380 patients with HF were evaluated. 86 patients had diastolic HF (I group) and 294 patients had systolic HF (II group). The control, III group consisted of 155 patients with left ventricular diastolic dysfunction but without HF. HF patients did not take any medication before ultrasound examination. All patients underwent thoracic X ray and ultrasound examination. Sonographic examination of a lung was done with 3.0-4.0 MgHz convex or sector probe, from 10 points on thoracic wall (cross points of midclavicular line II, IV and V intercostal spaces and anterior axilar line with IV and V spaces), which corresponded to the projection of lower, middle and upper lobes of right lung and upper and lower lobes of left lung. During pulmonary ultrasound examination 95.5% of patients with HF had "Comet tail phenomenon", which was registered only in 35.5% patients without HF (p>0.001). In DHF group "Comet tail phenomenon" was registered in 91.9% and in systolic HF group in 96.6% patients. In 81.4% of patients with DHF "Comet tail phenomenon" was registered from 3 and more registration points. In control group "Comet tail" was registered from more than 3 points only in 2 (1.3%) patients. The best results in diagnosis of DHF can be achieved if we take "3 and more registration points" as a reference point for diagnosis of pulmonary congestion (sensitivity - 0.911, specificity - 0.942, positive predictive value 0,975). In patients with diastolic HF during pulmonary ultrasound examination significantly often was registered "Comet tail phenomenon". The count of registration points from the thoracic wall of "Comet tail phenomenon" 3 and > is sensitive and specific sign of HF. We think that lung sonography offers a new method for the diagnosis of decompensated diastolic HF at bedside and may provide important information.