Assessing the Prognostic Value of Lung Ultrasound in Detecting Pulmonary Congestion in Acute Heart Failure Patients

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Background Pulmonary congestion, as opposed to low cardiac output, is the predominant cause of hospitalizations for heart failure and is associated with elevated mortality rates. Persisting congestion symptoms at discharge and during outpatient follow-ups are critical predictors of adverse outcomes. Lung ultrasound (LUS) has emerged as a simple, non-invasive tool for assessing pulmonary congestion. Objectives This study aims to evaluate the prognostic significance of pulmonary congestion detected via LUS in predicting short-term adverse events in patients hospitalized for acute heart failure (AHF). Methods We conducted a bi-centric prospective observational study involving consecutive patients admitted for AHF at two hospitals in Tunisia. Each participant underwent a thorough clinical assessment, biological evaluation, chest X-ray, LUS, and echocardiography. LUS operators were blinded to clinical data and examined eight thoracic zones. The primary outcomes included a composite of urgent care visits, rehospitalization due to acute heart failure decompensation, or cardiac death within a six-month follow-up. Results A total of 116 patients (median age: 69 years; 53% male; mean ejection fraction: 40%) were included. At discharge, the mean number of B-lines observed was 6.6 ± 3.3. During the follow-up period, we recorded 72 adverse events, with 52 patients experiencing severe heart failure symptoms requiring hospitalization and 20 dying from cardiac causes. Multivariate analysis indicated that the presence of ≥3 B-lines bilaterally significantly predicted the combined endpoint of rehospitalization or cardiac death at the six-month mark (HR: 11.024; 95% CI: 5.542-21.926; P < 0.001). Additionally, the number of B-lines decreased from 31.9 ± 12.7 upon admission to 6.6 ± 3.1 at discharge (P < 0.001). Conclusions The application of an 8-zone LUS protocol is effective in assessing the severity and monitoring the resolution of pulmonary congestion in heart failure patients. Persistent pulmonary congestion at discharge, as evaluated by LUS, correlates with a poorer prognosis.

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