Quantification of residual pulmonary congestion defined by B-line findings on lung ultrasound to predict cardiovascular events in acute heart failure: A systematic review and meta analysis

Kevin Fernando Suhardi; Pauliana Pauliana; Aqsha Tiara Viazelda

doi:10.1016/j.ihj.2025.05.003

May 5, 2025Indian Heart JournalOpen Access

Quantification of residual pulmonary congestion defined by B-line findings on lung ultrasound to predict cardiovascular events in acute heart failure: A systematic review and meta analysis

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Why the study?

Pulmonary congestion detected by LUS is a prognostic marker in AHF, but the prognostic significance of predischarge residual B-lines required systematic evaluation.

Does the presence of residual pulmonary congestion defined by B-lines on lung ultrasound before discharge predict adverse outcomes in hospitalized acute heart failure patients?

Structured PICO

Does the presence of residual pulmonary congestion defined by B-lines on lung ultrasound before discharge predict adverse outcomes in hospitalized acute heart failure patients?

P

Population

Hospitalized acute heart failure (AHF) patients from 15 studies

I

Intervention

Residual pulmonary congestion defined by B-line findings on lung ultrasound (LUS) before hospital discharge

C

Comparator

Absence or lower burden of residual B-lines on lung ultrasound

O

Outcome

Composite of all-cause mortality and heart failure (HF) rehospitalizationcomposite

Residual pulmonary congestion assessed by lung ultrasound B-lines at discharge is a strong independent predictor of mortality and heart failure rehospitalization in acute heart failure patients.

Implication

Residual B-lines may aid discharge risk stratification in AHF; leaves open whether LUS-guided decongestion improves outcomes.

Abstract

BACKGROUND: Pulmonary congestion detected by lung ultrasound (LUS) has emerged as a valuable prognostic marker in acute heart failure (AHF). This systematic review and meta-analysis aimed to evaluate the prognostic significance of residual B-lines identified by LUS before hospital discharge. METHODS: A comprehensive literature search of PubMed, Cochrane Library, ScienceDirect, and ClinicalTrials.gov was conducted up to October 4, 2024. Studies assessing the association between residual B-lines and adverse clinical outcomes in hospitalized AHF patients were included, while studies involving ambulatory assessments were excluded. The primary outcome was a composite of all-cause mortality and heart failure (HF) rehospitalization. Secondary outcomes included all-cause mortality and HF rehospitalization individually. Pooled hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated. RESULTS: Fifteen studies were included. Residual B-lines were significantly associated with an increased risk of composite outcomes (HR: 2.32; 95 % CI: 1.91-2.82), all-cause mortality (HR: 3.01; 95 % CI: 1.91-4.73), and HF readmission or cardiovascular events (HR: 4.01; 95 % CI: 2.22-7.24). Risk increased with greater B-line burden. Prognostic impact was stronger in short-term follow-up (<6 months; HR: 3.57) than in longer-term follow-up (≥6 months; HR: 1.96). CONCLUSIONS: Residual pulmonary congestion assessed by LUS at discharge is a strong independent predictor of adverse outcomes and may guide therapy decisions in AHF management.