SIMPLIFID LUNG ULTRASOUND IN DIAGNOSIS OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN ARTERIAL HYPERTENSION

Abstract

Objective: About 30% of patients with heart failure (HF) have normal Ejection Fraction (HFpEF). Pulmonary congestion is useful marker of HFpEF. The aim of this study was to determine the efficacy of ultrasound in patients with DHF. Design and method: We studied 250 patients with Arterial Hypertension and III-IV NYHA class HF from which 70 patients had HFpEF (group 1) and 100 patients Left Ventricular Diastolic Dysfunction but without signs of HF (control, group 2). All participants undergone standard Echo Cardiography. Sonographic evaluation of a lung was done in horizontal or vertical positions of patient, from 10 points of thoracic wall (5 points from each side), which corresponded to the projection of lower, middle and upper lobes of a right lung and upper and lower lobes of left lung. Results: In patients with HFpEF we significantly often found multiple (3 or more) B-lines or Comet tail Phenomenon (CTPh), which was registered in 91.1%. In 40.0% of control group patients, we also registered B-lines, but the count of them was less than 3 lines per each registration point (the difference between control an HF groups was significant). The count of points from where the CTPh was registered was 6.8 in HFpEF gr. and 0.7 in control. The B-lines were registered from 3 or more points of thoracic wall in 82.86% of patients of I gr and only 5% in II gr participants. In HF groups CTPh was prominent and multiple while in the control group it was single and short lasting, like lightening. There was good correlation between the count of B-line registration points from the thoracic wall and the heart failure NYHA class (r=0.56), left ventricular systolic (r=0.40) and diastolic (r=0.32) diameters and negative MAPS and TAPS (r=-0.42 and 0.41 respectively). Conclusions: Thoracic US is a sensitive and accurate method for evaluation pulmonary congestion in patients with AH and HFpEF. The US sign of pulmonary congestion in HF are B-lines or Comet tail phenomenon, which is protracted, prominent, multiple and registered from larger area of thoracic wall (3 points or more).