Point-of-Care lung ultrasound predicts in-Hospital mortality in acute heart failure.

BACKGROUND B-lines have been associated with adverse clinical outcomes in patients with heart failure (HF) when found at hospital discharge or during outpatient visits. Whether lung unltrasound (LUS) assessed B-lines may predict in-hospital mortality in patients with acute HF is still undetermined. AIM To evaluate the association between B-lines on admission and in-hospital mortality among patients admitted with acute HF. METHODS Hand-held LUS was used to examine patients with acute HF. LUS was performed in 8 chest zones with a pocket ultrasound device and analyzed offline. The association between B-lines and in-hospital mortality was assessed using Cox regression models. RESULTS We included 62 patients with median age 56 years, 69.4% men, and median left ventricle ejection fraction 25%. The sum of B-lines ranged from 0 to 53 (median 6.5). An optimal ROC-determined cut-off of ≥ 19 B-lines demonstrated a sensitivity of 57% and a specificity of 86% (AUC 0.788) for in-hospital mortality. The incremental prognostic value of LUS when compared with lung crackles or peripheral edema by integrated discrimination improvement was 12.96% (95% CI: 7.0, 18.8, p = 0.02). Patients with ≥19 B-lines had a four-fold higher risk of in-hospital mortality (HR 4.38; 95% CI: 1.37, 13.95, p < 0.01). CONCLUSION In patients admitted with acute HF, point-of-care LUS measurements of pulmonary congestion (B-lines) are associated with in-hospital mortality.