Øyvind Johannessen1,2, Brian Claggett3,4, Eldrin F Lewis5, John D Groarke3,4, Varsha Swamy3, Moritz Lindner6, Scott D Solomon3,4, Elke Platz3,4. 1. Faculty of Medicine,Institute of Clinical Medicine, University of Oslo, Oslo 0316, Norway. 2. Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway. 3. Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. 4. Harvard Medical School, Boston, MA 02115, USA. 5. Cardiovascular Division, Stanford University, San Francisco, CA 94305, USA. 6. Friedrich-Schiller-University, Jena 07737, Germany.
Abstract
AIMS: Lung ultrasound (LUS) relies on detecting artefacts, including A-lines and B-lines, when assessing dyspnoeic patients. A-lines are horizontal artefacts and characterize normal lung, whereas multiple vertical B-lines are associated with increased lung density. We sought to assess the prevalence of A-lines and B-lines in patients with acute heart failure (AHF) and examine their clinical correlates and their relationship with outcomes. METHODS AND RESULTS: In a prospective cohort study of adults with AHF, eight-zone LUS and echocardiography were performed early during the hospitalization and pre-discharge at an imaging depth of 18 cm. A- and B-lines were analysed separately off-line, blinded to clinical and outcome data. Of 164 patients [median age 71 years, 61% men, mean ejection fraction (EF) 40%], the sum of A-lines at baseline ranged from 0 to 19 and B-line number from 0 to 36. One hundred and fifty-six patients (95%) had co-existing A-lines and B-lines at baseline. Lower body mass index and lower chest wall thickness were associated with a higher number of A-lines (P trend < 0.001 for both). In contrast to B-lines, there was no significant change in the number of A-lines from baseline to discharge (median 6 vs. 5, P = 0.80). While B-lines were associated with 90-day HF readmission or death, A-lines were not [HR 1.67, 95% confidence interval (CI) 1.11-2.51 vs. HR 0.97, 95% CI 0.65-1.43]. CONCLUSIONS: A-lines and B-lines on LUS co-exist in the vast majority of hospitalized patients with AHF. In contrast to B-lines, A-lines were not associated with adverse outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Lung ultrasound (LUS) relies on detecting artefacts, including A-lines and B-lines, when assessing dyspnoeic patients. A-lines are horizontal artefacts and characterize normal lung, whereas multiple vertical B-lines are associated with increased lung density. We sought to assess the prevalence of A-lines and B-lines in patients with acute heart failure (AHF) and examine their clinical correlates and their relationship with outcomes. METHODS AND RESULTS: In a prospective cohort study of adults with AHF, eight-zone LUS and echocardiography were performed early during the hospitalization and pre-discharge at an imaging depth of 18 cm. A- and B-lines were analysed separately off-line, blinded to clinical and outcome data. Of 164 patients [median age 71 years, 61% men, mean ejection fraction (EF) 40%], the sum of A-lines at baseline ranged from 0 to 19 and B-line number from 0 to 36. One hundred and fifty-six patients (95%) had co-existing A-lines and B-lines at baseline. Lower body mass index and lower chest wall thickness were associated with a higher number of A-lines (P trend < 0.001 for both). In contrast to B-lines, there was no significant change in the number of A-lines from baseline to discharge (median 6 vs. 5, P = 0.80). While B-lines were associated with 90-day HF readmission or death, A-lines were not [HR 1.67, 95% confidence interval (CI) 1.11-2.51 vs. HR 0.97, 95% CI 0.65-1.43]. CONCLUSIONS: A-lines and B-lines on LUS co-exist in the vast majority of hospitalized patients with AHF. In contrast to B-lines, A-lines were not associated with adverse outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Anna Maria Chiesa; Federica Ciccarese; Greta Gardelli; Ugo Maria Regina; Francesco Feletti; Maria Letizia Bacchi Reggiani; Maurizio Zompatori Journal: J Clin Ultrasound Date: 2014-09-15 Impact factor: 0.910
Authors: Elke Platz; Pardeep S Jhund; Nicolas Girerd; Emanuele Pivetta; John J V McMurray; W Frank Peacock; Josep Masip; Francisco Javier Martin-Sanchez; Òscar Miró; Susanna Price; Louise Cullen; Alan S Maisel; Christiaan Vrints; Martin R Cowie; Salvatore DiSomma; Hector Bueno; Alexandre Mebazaa; Danielle M Gualandro; Mucio Tavares; Marco Metra; Andrew J S Coats; Frank Ruschitzka; Petar M Seferovic; Christian Mueller Journal: Eur J Heart Fail Date: 2019-06-19 Impact factor: 15.534
Authors: Philip Brainin; Brian Claggett; Eldrin F Lewis; Kristin H Dwyer; Allison A Merz; Montane B Silverman; Varsha Swamy; Tor Biering-Sørensen; Jose Rivero; Susan Cheng; John J V McMurray; Scott D Solomon; Elke Platz Journal: ESC Heart Fail Date: 2020-02-20