A-lines and B-lines in patients with acute heart failure

Eur Heart J Acute Cardiovasc Care. 2021 Oct 27;10(8):909-917. doi: 10.1093/ehjacc/zuab046.


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.

Keywords: A-lines; Acute heart failure; B-lines; Lung ultrasound; Pulmonary congestion.

MeSH terms

  • Adult
  • Aged
  • Female
  • Heart Failure* / diagnosis
  • Heart Failure* / epidemiology
  • Humans
  • Lung / diagnostic imaging
  • Male
  • Prognosis
  • Prospective Studies
  • Pulmonary Edema*
  • Ultrasonography