Table 1.
Diagnostic accuracy of different LUS analyses in pulmonary congestion evaluations compared with clinical congestion evaluation NPs measurements and relationship with echocardiographic parameters.
| AHF | ||||||
| Author of the study | N. patients | B-lines number/score | Congestion signs, n (%) |
NT-proBNP/
BNP (pg/mL) |
Eco parameters admission | Accuracy |
| Coiro et al. (2015) [41] | 60 | Assessed on 8 and 28 chest zones. Method: score and count. Score ≥ 3 zone: positive zones. Count: sum of B-lines in all zones > 30 |
Crackles: 18 (30%); Leg edema: 11 (18%) |
BNP: 575 (228.5–1147) | E/E′: 19.11 ± 9.5; IVC diameter (mm): 19.71 ± 5.16; TAPSE (mm): 17.26 ± 3.8; EF (%): 37.5% ± 15 |
Outcome: composite: 3-month HF hospitalization or death. ≥30 B-lines (HR 5.66, 95% Cl 1.74–18.39, p = 0.04) |
| Gargani et al. (2015) [40] | 100 | Assessed on 28 chest zones. Method: score and count. Score: mild: 6–15 B-lines; moderate: 16–30 B-lines; severe: > 30 B-lines. Count: sum of B-lines in all zones |
Not assessed | NT-proBNP: 5291 ± 5877 | Pseudonormal pattern 11%; Restrictive pattern 23%; PAPs (mmHg): 49 ± 15; TAPSE (mm): 16.5 ± 4.7 |
Outcome: composite HF hospitalization or death (mean follow-up 159 days). >15 B-lines- readmission for HF. Sens: 100% spec: 64.8%. >20 B-lines- readmission for HF. Sens: 100% spec: 74.7% NPV: 100% |
| Cogliati et al. (2016) [45] | 149 | Assessed on 8 and 28 chest zones. Method: Score (8 zones) Count (28 zones). Score: ≥3 B-lines per zone: positive zone. Count: sum of B-lines in all zones. Count: total B-lines > 15; Total B-lines > 30 |
Peripheral edema, JVT (jugular vein turgescence) and pulmonary crackles. |
NT-proBNP: 2407 ± 1400 | E/E′ > 15. 41.6% pz (49) TAPSE (mm): 16.5 |
Outcome: composite 100-day HF hospitalization or all-cause death. Correlation between the sonographic score and event occurrence (HR 1.19; CI 1.05 to 1.34; p = 0.005) increase of 24% the risk of outcome. |
| Cortellaro et al. (2016) [43] | 41 | Assessed on 11 chest zones. Method: Score. <3 B-lines in a zone (0 points); ≥3 B-lines in ≥1 zone (1 point); multiple/confluent B-lines (2 points) |
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, rales | NTproBNP: 5867 ± 6112 | After therapy: IVC diameter (cm): 1.9 ± 0.5 TAPSE (mm) 20.0 ± 3.5 PAPs (mmHg) 37.2 ± 9.8 E/E′: 14.8 ± 5.2 |
Mean B-score significantly decreased at T3 (from 1.59 ± 0.40 to 0.73 ± 0.44, p < 0.001) and between T3 and T 24 (from 0.73 ± 0.44 to 0.38 ± 0.33, p < 0.001). |
| Palazzuoli et al. (2018) [46] | 162 | B-line count > 22 | Crackles: 140 (86%) Hepatomegaly: 56 (35%) 3th tone: 48 (41%) JVD: 68 (42%) Leg edema: 102 (63%) |
BNP HFrEF: 1164 ± 420 BNP HfpEF: 889 ± 130 |
E/e′: 16 ± 4 TAPSE (mm) 20 ± 4 |
Sens: 70%; spec: 81%; accuracy: 76% |
| CHF | ||||||
| Author of the study | N. patients | B-lines number/score | Congestion signs, n (%) |
NT-proBNP/
BNP (pg/mL) |
Eco parameters admission | Accuracy |
| Miglioranza et al. (2013) [39] | 97 | Score ≥ 3 zone: positive zone > 15 | CCS > 2: 44 (66.7%) s3–s4: 7 (7%) |
NT-proBNP: 3070 ± 3100 | E/e′: 23 ± 16; PAPm: 39.1 ± 10.9; |
Combining NT-proBNP > 1000 pg/mL and/or E/e′ > 15: yielded a C-statistic of 0.89 for LUS spec: 83.3%; sens: 84.9%; AUC delta: 0.194, 95% CI 0.147, 0.315; p = 0.001 primary outcome |
| Platz et al. (2016) [37] | 185 | Assessed on 8 chest zones. Method: count. Sum of B-lines in all zones Score ≥ 3 zone: positive zone > 15 |
Crackles: 35 (19%) JVD: 68 (37%) Leg edema: 65 (35%) |
NT-proBNP: 5086 (3023–9248) | EF < or ≥ 45% | Outcome: composite: 6-month HF hospitalization or all-cause mortality. AUC delta: 0.132, 95% CI 0.078, 0.213; p < 0.001) |
| Gustafsson et al. (2015) [47] | 104 | Assessed on 5 chest zones. Method: count and score. Score: ≥ 3 B-lines in one zone. Count sum of B-lines in all zones. |
Not assessed | NT-proBNP: 1820 ± 1000 | IVC diameter (mm): 18 ± 4 | Outcome: composite 6-month HF hospitalization or all-cause mortality. B-lines cox proportional HR adjusted for age > 72, NT-proBNP and LV function. B-lines > 3 (HR 2.9 (1.3–6.6), p = 0.11, HR 3.5 (1.5–7.9), 0.003; Age > 72 HR 0.3 (0.2–0.8), p = 14; EF <40% HR 0.7 (0.3–1.6) p = 0.70; NT-proBNP HR 3.5 (1.5–8.5) p = 0.005 |
| Pellicori et al. (2019) [48] | 342 | Assessed on 28 chest zones. Method: count. B-lines (≥14) |
Crackles: 40 (11.7%) JVP: 55 (16.1%) peripheral edema: 103 (30.1%) No signs of congestion: 205 (59.9%) |
NT-ProBNP HFrEF: 1494 (684–3502) HFmrEF: 1330 (382–2881) HFpEF: 1100 (354–1994) |
JVD RATIO mediana: 5.3 TAPSE (mm) mediana: 19 E/e′ lat: mediana: 11 IVC diameter (cm): 2.0 |
Outcome: (Composite of all-cause mortality or heart failure hospitalization). B-lines-HR: 1.02 (1.01–1.03); Chi2: 26.3; p < 0.001 |