Lung ultrasound examination in diagnosis of pulmonary congestion in ambulatory praxis

Background Pulmonary congestion is a condition associated with volume distribution and overload in Heart Failure (HF). Early detection of pulmonary congestion is crucial in optimization treatment. Lung Sonography is a valuable tool in differential diagnosis of dyspnea and detection of pulmonary congestion in outpatient setting. Material and Methods We studied 440 patients with II-III NYHA class (110 patients with HFmidEF, 200 – HFrEF and 130 - with HFpEF). and 100 - with different cardiac disorders but without signs of HF (control gr.). Diagnosis of heart failure was done according to recommendation of Universal Definition of Heart failure). 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 HF significantly often was found B-lines or "Comet tail Phenomenon" (CTPh), which was registered in 92 %. In 40.0% of control group, we also registered B-lines, but the count of them in 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 B lines was registered was 6.9 in EF gr. and 0.7 in control gr. Multiple (3 or more) B-lines were registered from 3 or more points of thoracic wall in 86% of patients and only in 5% of control. In HF groups B lines where multiple (> 2 B-lines from registration point) and long lasting, while in the control group it was single (<3 B-lines from registration point) 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, systolic pulmonary artery pressure and negative correlation with MAPS and TAPS (r=-0.42 and 0.41 respectively). Conclusion Thoracic US is sensitive and accurate method for evaluation pulmonary congestion in patients with HF. The US sign of pulmonary congestion in HF, B-lines, are multiple, long lasting and registered from larger area of thoracic wall (3 or more registration points).