Key result
Severe lung ultrasound B-lines linked to ~2.6-fold higher mortality in chronic coronary syndromes.
Why the study?
The prognostic value of pulmonary congestion detected by lung ultrasound B-lines, when integrated with resting transthoracic echocardiography, was undefined in chronic coronary syndromes.
Does resting lung ultrasound B-line assessment predict all-cause mortality in patients with chronic coronary syndromes?
Cohort (n=7,194)
Yes
Does resting lung ultrasound B-line assessment predict all-cause mortality in patients with chronic coronary syndromes?
Resting lung ultrasound B-lines provide incremental prognostic value beyond age and standard echocardiographic LVEF for predicting all-cause mortality in patients with chronic coronary syndromes across all ejection fraction categories.
May refine mortality risk stratification beyond LVEF in chronic coronary syndromes; extends prior echo data but remains hypothesis-generating.
Background Pulmonary congestion, detected by lung ultrasound (LUS) B-lines, is a key sign of hemodynamic impairment. Its prognostic value, integrated with resting transthoracic echocardiography (TTE), is undefined in chronic coronary syndromes (CCS). Methods In a prospective, international, multicenter study, 7,194 patients underwent a resting TTE for left ventricular (LV) ejection fraction (EF) by Simpson’s method and a simplified 4-site LUS exam for evaluation of CCS. B-lines were categorized as 0-1 (absent, score 0), 2-4 (mild, score 1), 5-9 (moderate, score 2), and ≥10 (severe, score 3). The endpoint was all-cause mortality. Results Pulmonary congestion (≥2 B-lines) was present in 1096 patients (15.2%). LV EF was 59.7±9.0%. EF and B-lines showed a linear, weak, negative correlation (r = -0.125, p < 0.001). During a median follow-up of 29 months (interquartile range:13-39 months), 219 deaths occurred. Presence of B-lines was associated with increased 6-year mortality in the 761 patients with EF <50% (13.4% vs 3.7%, chi-square= 16.09, p<0.0001) and in the 6433 patients with EF ≥50% (5.8% vs 2.1%, chi-square= 24.86, p<0.0001). The exposure-adjusted death rate was lowest in patients with a B-lines score of 0 (0.97 per 100 person-years), and increased progressively in scores 1 (2.16 per 100 person-years), 2 (3.06 per 100 person-years), and 3 (5.19 per 100 person-years; p < .001 for trend and intergroup differences): figure. Multivariable Cox analysis identified: age (HR 1.05, 95% CI 1.04–1.07, p<0.001),LVEF (HR 0.97, 95% CI 0.96–0.99, p<0.001), and B-lines score 1-mild (HR 1.71, 95% CI 1.21–2.42, p=0.002), 2-moderate (HR 2.33, 95% CI 1.43–3.78, p=0.001), and 3-severe (HR 2.64, 95% CI 1.57–4.44, p<0.001) as independent predictors of mortality. Conclusions In a large CCS cohort, resting LUS B-lines provide powerful, incremental prognostic information beyond age and standard TTE-based EF for predicting mortality. B-line score of increasing severity is associated with worse outcomes across all values of EF.Mortality rate and resting B-lines.
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Campagnano et al. (2026) conducted a cohort in Chronic coronary syndromes (n=7,194). Pulmonary congestion (resting lung ultrasound B-lines) vs. Absent B-lines (0-1 B-lines, score 0) was evaluated on All-cause mortality (HR 2.64, 95% CI 1.57-4.44, p=<0.001). Resting lung ultrasound B-lines independently predicted all-cause mortality in chronic coronary syndromes, with severe congestion conferring an HR of 2.64 (95% CI 1.57-4.44; p<0.001).
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