Lung ultrasound guided management in chronic heart failure- an updated systematic review and meta-analysis of randomised controlled trials

Abstract Introduction Existing systematic reviews support the prognostic and therapeutic value of lung ultrasound (LUS) in heart failure (HF), but recent randomised controlled trials (RCTs) in chronic HF justify an up-to-date synthesis. Methods A systematic search of OVID via Medline, SCOPUS, COCHRANE and CINAHL was conducted from inception until February 25th, 2025. The study was registered with PROSPERO (ID: CRD420251003434). RCTs of LUS interventions in patients with chronic HF were included. The primary outcomes were HF urgent visits and HF hospitalisations. Secondary outcomes included mortality, hypokalaemia and worsening renal function. Results Five RCTs, involving a total of 694 patients, were included in meta-analyses, with variability in LUS-based definitions of pulmonary congestion across studies. LUS-guided management was associated with a significant reduction in HF urgent visits (RR 0.31 95% CI 0.17, 0.55, I2= 0%) and a non-significant improvement in HF hospitalisations (RR 0.76 95% CI 0.48, 1.18, I2= 38.9%). There was no difference in the rates of mortality, hypokalaemia or worsening renal function. Conclusions LUS- guided management is associated with a significant reduction in urgent HF visits and a non-significant reduction in HF hospitalisations, with no difference in rates of mortality, hypokalaemia or worsening renal function. Future studies should aim to establish an optimal, standardised LUS-based definition of pulmonary congestion in chronic heart failure.