Radio diagnosis

The researches find that the lung ultrasound (LUS) examinations, which show likely subclinical pulmonary congestion; in outpatients with heart failure (HF). therefore The blinking appearance of “B lines” on LUS images, an artifact cause by echo differences between tissue and accumulated fluid; is a confirmed diagnostic and prognostic indicator of congestion. More B lines; But also called ultrasound lung comets for the way they streak across the scan from the pleural line; mean more fluid..

Subclinical pulmonary congestion

The current study suggests the lines could potentially serve as a target for managing volume-depletion therapy, in that adding diuretics in response to them might improve clinical outcomes. Therefore There was a marginally significant 48% decline in 6-month risk for a clinical composite primary endpoint; driven by a more highly significant 75% drop in urgent clinic visits for worsening HF in recently discharge patients whose outpatient diuretic therapy was guide by B lines on LUS.

Scans are obtain using highly portable; pocket-size systems in all patients, and clinicians who used their findings to adjust diuretics in those assigned to guide therapy didn’t follow a defined treatment protocol. Because of that; the patient population numbering only about 120 from one center; the marginal primary outcome, and other reasons; the study dubbed LUS-HF is more food for thought than an endorsement of LUS-guided HF therapy.

Defined treatment protocol

“We propose lung ultrasound as a tool to complement clinical examination and to detect subclinical congestion;” said Mercedes Rivas-Lasarte, MD, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, during the presentation of LUS-HF here at European Society of Cardiology Heart Failure (ESC-HF) 2019.

“The lung-ultrasound guided strategy was safe and reduced the number of decompensations,” Lasarte said. “We think that lung ultrasound is a rapid, easy, inexpensive, and broadly available tool that may be recommended in heart failure follow-up to improve outcomes.” However; regarding the use of B lines on LUS to guide diuretic therapy, Lasarte added, “We have to take our study as a proof of concept; and we think that multicenter studies are needed to confirm our results and to test harder endpoints.”

Number of decompensations

Even though there is no treatment protocol in the study; how clinicians manage diuretics for the patients are a good reflection of real-world practice; says Peter S. Pang, MD, Indiana University, Indianapolis, an emergency physician and early adopter of LUS in patients with HF.

The trial’s primary endpoint; which included mortality and urgent clinic visit or rehospitalization for worsening HF; may have been significantly reduce in the LUS-guided group; “but I think we need to be careful how they interpret the positive trial because it is drive only by urgent heart-failure visits;” Pang, who was not involve in LUS-HF.