Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure

Eur J Heart Fail. 2015 Nov;17(11):1172-81. doi: 10.1002/ejhf.344. Epub 2015 Sep 29.


Aims: Residual pulmonary congestion at discharge is associated with poor prognosis in heart failure (HF), but its quantification through physical examination is challenging. Ultrasound imaging of lung comets (B-lines) could improve congestion evaluation. The aim of this study was to assess the short-term prognostic value of B-lines after discharge from HF hospitalisation compared with other indices of haemodynamic congestion (BNP, E/e', and inferior vena cava diameter) or clinical status (NYHA class).

Methods and results: Sixty consecutive HF inpatients underwent clinical examination, echocardiography, and lung ultrasound at discharge, independently of, and in addition to routine management by the attending physicians. The median B-line count was 8.5 (5-34). Three-month event-free survival for the primary endpoint (all-cause death or HF hospitalisation) was 27 ± 10% in patients with ≥30 B-lines and 88 ± 5% in those with <30 B-lines (P < 0.0001). In a multivariable model, ≥30 B-lines significantly predicted the combined endpoint (hazard ratio 5.66, 95% confidence interval 1.74-18.39, P = 0.04), along with NYHA ≥III and inferior vena cava diameter, while other indirect measures of congestion (BNP and E/e' ≥15) were not retained in the model; furthermore ≥30 B-lines independently also predicted the secondary outcomes (HF hospitalisation and death). Importantly, B-line addition to NYHA class and BNP was associated with improved risk classification (integrated discrimination improvement 15%, P = 0.02; continuous net reclassification improvement 65%, P = 0.03).

Conclusion: Residual pulmonary congestion at discharge, as assessed by a B-line count ≥30, is a strong predictor of outcome. Lung ultrasonography may represent a useful tool to identify and monitor congestion and optimize therapy during and/or after hospitalisation for HF, which should be further validated in multicentre studies.

Keywords: B-lines; Chest ultrasound; Heart failure; Lung ultrasound; Pulmonary congestion.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Continuity of Patient Care
  • Disease Management
  • Echocardiography / methods
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Heart Failure* / complications
  • Heart Failure* / diagnosis
  • Heart Failure* / epidemiology
  • Heart Failure* / physiopathology
  • Heart Failure* / therapy
  • Humans
  • Lung / diagnostic imaging*
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Natriuretic Peptide, Brain / blood
  • Patient Discharge / statistics & numerical data
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Pulmonary Edema / blood
  • Pulmonary Edema / diagnosis
  • Pulmonary Edema / etiology
  • Pulmonary Edema / mortality
  • Pulmonary Edema / physiopathology
  • Retrospective Studies


  • Natriuretic Peptide, Brain