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Lung ultrasound in acute myocardial infarction. Updating Killip & Kimball

Jorge I Parras1, Mariela Onocko1, Liliana M Traviesa2

  • 1Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina.

Indian Heart Journal
|March 14, 2021
PubMed

Insights

Lung ultrasound effectively predicts heart failure in acute myocardial infarction patients. A high count of B-lines on admission indicates increased risk, aiding early diagnosis and management.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Critical Care Medicine

Background:

  • Acute myocardial infarction (AMI) frequently leads to heart failure, a serious complication with poor prognosis.
  • The Killip and Kimball classification is a standard tool for assessing heart failure in AMI patients.
  • Lung ultrasound (LUS) can detect pulmonary congestion, but its utility in AMI-related heart failure is not well-established.

Purpose of the Study:

  • To determine the diagnostic accuracy of lung ultrasound (LUS) in predicting heart failure development in patients with acute myocardial infarction (AMI).

Main Methods:

  • A prospective study evaluated 200 AMI patients without initial heart failure using lung ultrasound.
  • Lung ultrasound B-lines were counted, and patients were monitored for new heart failure (Killip Class B, C, or D) by a blinded cardiologist.
  • Receiver Operating Characteristic (ROC) curve analysis assessed the accuracy of B-line counts in predicting heart failure.

Main Results:

  • Patients who developed heart failure had a median of 14 B-lines, significantly higher than the 2 B-lines in those remaining Killip Class A (p < 0.0001).
  • The area under the ROC curve for predicting heart failure using B-lines was 0.91 (95% CI 0.86-0.97).
  • A threshold of 5 B-lines demonstrated 88% sensitivity and 81% specificity for predicting heart failure.

Conclusions:

  • Lung ultrasound performed at admission is a valuable tool for predicting the onset of heart failure in patients experiencing acute myocardial infarction.
  • The presence and number of B-lines on lung ultrasound can assist clinicians in identifying high-risk patients early.
Abstract

Keywords:
Heart failureMyocardial infarctionUltrasound

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