A Simplified Ultrasound Comet Tail Grading Scoring to Assess Pulmonary Congestion in Patients with Heart Failure

Biomed Res Int. 2018 Jan 2;2018:8474839. doi: 10.1155/2018/8474839. eCollection 2018.


Ultrasound lung comets (ULCs) are a nonionizing bedside approach to assess extravascular lung water. We evaluated a protocol for grading ULC score to estimate pulmonary congestion in heart failure patients and investigated clinical and echocardiographic correlates of the ULC score. Ninety-three patients with congestive heart failure, admitted to the emergency department, underwent pulmonary ultrasound and echocardiography. A ULC score was obtained by summing the ULC scores of 7 zones of anterolateral chest scans. The results of ULC score were compared with echocardiographic results, the New York Heart Association (NYHA) functional classification, radiologic score, and N-terminal pro-b-type natriuretic peptide (NT-proBNP). Positive linear correlations were found between the 7-zone ULC score and the following: E/e', systolic pulmonary artery pressure, severity of mitral regurgitation, left ventricular global longitudinal strain, NYHA functional classification, radiologic score, and NT-proBNP. However, there was no significant correlation between ULC score and left ventricular ejection fraction, left ventricle diameter, left ventricular volume, or left atrial volume. A multivariate analysis identified the E/e', systolic pulmonary artery pressure, and radiologic score as the only independent variables associated with ULC score increase. The simplified 7-zone ULC score is a rapid and noninvasive method to assess lung congestion. Diastolic rather than systolic performance may be the most important determinant of the degree of lung congestion in patients with heart failure.

MeSH terms

  • Aged
  • Echocardiography / methods
  • Extravascular Lung Water / metabolism
  • Extravascular Lung Water / physiology
  • Female
  • Heart Failure / metabolism
  • Heart Failure / physiopathology*
  • Heart Ventricles / metabolism
  • Heart Ventricles / physiopathology
  • Humans
  • Lung / metabolism
  • Lung / physiopathology*
  • Male
  • Natriuretic Peptide, Brain / metabolism
  • Peptide Fragments / metabolism
  • Prospective Studies
  • Pulmonary Circulation / physiology
  • Pulmonary Edema / metabolism
  • Pulmonary Edema / physiopathology
  • Ultrasonography / methods
  • Ventricular Function, Left / physiology


  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain