The application and progress of pulmonary ultrasound in congestive heart failure_West China Medical Journal

Authors：

ZHAO Yan ^1,2 , HUANG Yanping ^1,2 , LI Tongyao ¹ ,  ZHANG Shu ¹

1. Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Emergency Department, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

ZHANG Shu, Email: dr.zhangshu@qq.com

Keywords：

Congestive heart failure; Lung ultrasound; B line

DOI：

10.7507/1002-0179.201901142

Video：

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In recent years, with the development of ultrasound technology, pulmonary ultrasound is more and more used in the evaluation of patients with heart failure. B-lines are defined as reverberation artifacts starting from the pleural line and extending to the bottom of the screen without disappearing, and moving synchronously with pleural sliding, which are proportional to extravascular lung water in congestive heart failure (CHF). B-lines have the characteristics of no attenuation and synchronous movement with pleural sliding. Pulmonary ultrasound mainly record the numbers and widths of B-lines in the areas when assessing the severity of CHF, which have the characteristics of effectivity, non-invasiveness, instantaneousness, and good repeatability. Currently, there are 4-, 8-, 12-, and 28-subdivision methods for the evaluation of CHF in the pulmonary ultrasound subdivision method. The more subdivisions are, the longer the operation time will be, and the sensitivity and specificity will be different. How to choose a subdivision method is still controversial in clinical practice. Lung ultrasound could be used alone or combined with brain natriuretic peptide, echocardiography, chest X-ray, chest CT scan, etc. in the early diagnosis, assessment of disease severity, evaluation of efficacy, and assessment of prognosis of CHF, with different advantages and disadvantages. This article reviews the application and progress of pulmonary ultrasound in CHF.

Citation： ZHAO Yan, HUANG Yanping, LI Tongyao, ZHANG Shu. The application and progress of pulmonary ultrasound in congestive heart failure. West China Medical Journal, 2019, 34(4): 443-447. doi: 10.7507/1002-0179.201901142 Copy

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2.	Maggioni AP, Dahlström U, Filippatos G, et al. EURO bservational research programme: the heart failure pilot survey (ESC-HF Pilot). Eur J Heart Fail, 2014, 12(10): 1076-1084.
3.	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail, 2016, 18(8): 891-975.
4.	庄燕, 戴林峰, 陈明祺, 等. 床旁肺超声B线积分对急性左心衰竭的诊断价值. 中华危重病急救医学, 2018, 30(2): 156-159.
5.	Palazzuoli A, Ruocco G, Beltrami M, et al. Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF. Clin Res Cardiol, 2018, 107(7): 586-596.
6.	床旁超声在急危重症临床应用专家共识组. 床旁超声在急危重症临床应用的专家共识. 中华急诊医学杂志, 2016, 25(1): 10-21.
7.	Liteplo AS, Marill KA, Villen T, et al. Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med, 2009, 16(3): 201-210.
8.	Lichtenstein DA. Whole body ultrasonography in the critically ill. Springer Berlin Heidelberg, 2010.
9.	Koegelenberg CFN, Diacon A, Bolliger CT. Transthoracic ultrasound for chest wall, pleura, and the peripheral lung. Progress in Respiratory Research, 2009, 37: 22-33.
10.	Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med, 2012, 38(4): 577-591.
11.	Leidi F, Casella F, Cogliati C. Bedside lung ultrasound in the evaluation of acute decompensated heart failure. Intern Emerg Med, 2016, 11(4): 597-601.
12.	Enghard P, Rademacher S, Nee J, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care, 2015, 19: 36.
13.	Sartini S, Frizzi J, Borselli M, et al. Which method is best for an early accurate diagnosis of acute heart failure? Comparison between lung ultrasound, chest X-ray and NT pro-BNP performance: a prospective study. Intern Emerg Med, 2017, 12(6): 861-869.
14.	Coiro S, Porot G, Rossignol P, et al. Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: a two-centre cohort study. Sci Rep, 2016, 6: 39426.
15.	Gargani L, Frassi F, Soldati G, et al. Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides. Eur J Heart Fail, 2008, 10(1): 70-77.
16.	李虹, 李一丹, 吕秀章, 等. 肺超声联合超声心动图评价左心衰患者的临床研究. 中国超声医学杂志, 2016, 32(8): 696-699.
17.	Michard F. Bedside assessment of extravascular lung water by dilution methods: temptations and pitfalls. Crit Care Med, 2007, 35(4): 1186-1192.
18.	Cardinale L, Priola AM, Moretti F, et al. Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure. World J Radiol, 2014, 6(6): 230-237.
19.	Al Deeb M, Barbic S, Featherstone R, et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med, 2014, 21(8): 843-852.
20.	Picano E, Frassi F, Agricola E, et al. Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr, 2006, 19(3): 356-363.
21.	Trezzi M, Torzillo D, Ceriani E, et al. Lung ultrasonography for the assessment of rapid extravascular water variation: evidence from hemodialysis patients. Intern Emerg Med, 2013, 8(5): 409-415.
22.	Öhman J, Harjola VP, Karjalainen P, et al. Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure. ESC Heart Fail, 2018, 5(1): 120-128.
23.	Coiro S, Rossignol P, Ambrosio G, et al. Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure. Eur J Heart Fail, 2015, 17(11): 1172-1181.
24.	Gargani L, Pang PS, Frassi F, et al. Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study. Cardiovasc Ultrasound, 2015, 13: 40.
25.	Platz E, Merz AA, Jhund PS, et al. Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. Eur J Heart Fail, 2017, 19(9): 1154-1163.
26.	Pivetta E, Goffi A, Nazerian P, et al. Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial. Eur J Heart Fail, 2019.
27.	Pivetta E, Goffi A, Lupia E, et al. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest, 2015, 148(1): 202-210.

1. Mentz RJ, Stevens SR, DeVore AD, et al. Decongestion strategies and renin-angiotensin-aldosterone system activation in acute heart failure. JACC Heart Fail, 2015, 3(2): 97-107.
2. Maggioni AP, Dahlström U, Filippatos G, et al. EURO bservational research programme: the heart failure pilot survey (ESC-HF Pilot). Eur J Heart Fail, 2014, 12(10): 1076-1084.
3. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail, 2016, 18(8): 891-975.
4. 庄燕, 戴林峰, 陈明祺, 等. 床旁肺超声B线积分对急性左心衰竭的诊断价值. 中华危重病急救医学, 2018, 30(2): 156-159.
5. Palazzuoli A, Ruocco G, Beltrami M, et al. Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF. Clin Res Cardiol, 2018, 107(7): 586-596.
6. 床旁超声在急危重症临床应用专家共识组. 床旁超声在急危重症临床应用的专家共识. 中华急诊医学杂志, 2016, 25(1): 10-21.
7. Liteplo AS, Marill KA, Villen T, et al. Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med, 2009, 16(3): 201-210.
8. Lichtenstein DA. Whole body ultrasonography in the critically ill. Springer Berlin Heidelberg, 2010.
9. Koegelenberg CFN, Diacon A, Bolliger CT. Transthoracic ultrasound for chest wall, pleura, and the peripheral lung. Progress in Respiratory Research, 2009, 37: 22-33.
10. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med, 2012, 38(4): 577-591.
11. Leidi F, Casella F, Cogliati C. Bedside lung ultrasound in the evaluation of acute decompensated heart failure. Intern Emerg Med, 2016, 11(4): 597-601.
12. Enghard P, Rademacher S, Nee J, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care, 2015, 19: 36.
13. Sartini S, Frizzi J, Borselli M, et al. Which method is best for an early accurate diagnosis of acute heart failure? Comparison between lung ultrasound, chest X-ray and NT pro-BNP performance: a prospective study. Intern Emerg Med, 2017, 12(6): 861-869.
14. Coiro S, Porot G, Rossignol P, et al. Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: a two-centre cohort study. Sci Rep, 2016, 6: 39426.
15. Gargani L, Frassi F, Soldati G, et al. Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides. Eur J Heart Fail, 2008, 10(1): 70-77.
16. 李虹, 李一丹, 吕秀章, 等. 肺超声联合超声心动图评价左心衰患者的临床研究. 中国超声医学杂志, 2016, 32(8): 696-699.
17. Michard F. Bedside assessment of extravascular lung water by dilution methods: temptations and pitfalls. Crit Care Med, 2007, 35(4): 1186-1192.
18. Cardinale L, Priola AM, Moretti F, et al. Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure. World J Radiol, 2014, 6(6): 230-237.
19. Al Deeb M, Barbic S, Featherstone R, et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med, 2014, 21(8): 843-852.
20. Picano E, Frassi F, Agricola E, et al. Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr, 2006, 19(3): 356-363.
21. Trezzi M, Torzillo D, Ceriani E, et al. Lung ultrasonography for the assessment of rapid extravascular water variation: evidence from hemodialysis patients. Intern Emerg Med, 2013, 8(5): 409-415.
22. Öhman J, Harjola VP, Karjalainen P, et al. Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure. ESC Heart Fail, 2018, 5(1): 120-128.
23. Coiro S, Rossignol P, Ambrosio G, et al. Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure. Eur J Heart Fail, 2015, 17(11): 1172-1181.
24. Gargani L, Pang PS, Frassi F, et al. Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study. Cardiovasc Ultrasound, 2015, 13: 40.
25. Platz E, Merz AA, Jhund PS, et al. Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. Eur J Heart Fail, 2017, 19(9): 1154-1163.
26. Pivetta E, Goffi A, Nazerian P, et al. Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial. Eur J Heart Fail, 2019.
27. Pivetta E, Goffi A, Lupia E, et al. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest, 2015, 148(1): 202-210.

West China Medical Journal

The application and progress of pulmonary ultrasound in congestive heart failure

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