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Updated: May 13, 2025
Point-of-Care Lung Ultrasound in Adults: Image Acquisition
Published on: March 3, 2023
Diagnostic value of lung ultrasound B-lines for evaluating left ventricular filling pressure
Takahiro Sakamoto1,2, Toshihiko Asanuma3, Hiroyuki Sasaki3,4
1Division of Cardiology, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan. sakamoto.takahiro@ncvc.go.jp.
Insights
Lung ultrasound B-lines show promise as an alternative diagnostic tool for assessing left ventricular (LV) diastolic dysfunction. This method may offer improved specificity compared to traditional echocardiographic indices, aiding in heart failure risk stratification.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Medical Imaging
Background:
- Echocardiographic assessment of left ventricular (LV) diastolic function via American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) guidelines can be inconclusive.
- Lung ultrasound B-lines are emerging as a potential indicator of pulmonary congestion.
Purpose of the Study:
- To evaluate the association between lung ultrasound B-lines and LV diastolic function.
- To determine if B-lines can serve as an alternative to conventional echocardiographic indices for assessing LV diastolic function.
- To examine the relationship between B-lines and the risk of heart failure hospitalization.
Main Methods:
- Prospective study of 172 patients with pre-heart failure (HF) or HF.
- Investigated the relationship between B-lines and LV diastolic function using echocardiography.
- Assessed the diagnostic accuracy of B-lines for estimating LV filling pressures and their correlation with HF hospitalization risk.
Main Results:
- B-lines increased with the severity of LV diastolic dysfunction grade.
- LV filling pressure significantly correlated with B-lines (r=0.690, P<0.001).
- B-lines demonstrated comparable sensitivity but improved specificity over tricuspid regurgitation peak gradient (TRPG) for diagnosing diastolic dysfunction. High B-line count was associated with increased HF hospitalization risk.
Conclusions:
- Lung ultrasound B-lines show potential as a valuable alternative for assessing LV diastolic dysfunction.
- B-lines may improve diagnostic accuracy and aid in predicting heart failure prognosis.
Background:
The assessment of left ventricular (LV) diastolic function based on the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guidelines requires measurement of several echocardiographic indices. However, these assessments often yield inconclusive results owing to the absence of measurable parameters. Multiple B-lines on lung ultrasound have been proposed as a method for evaluating pulmonary congestion. We aimed to evaluate the association between B-lines and LV diastolic function and to examine whether B-lines show potential as an alternative to conventional indices for assessing LV diastolic function.
Methods:
This prospective study included 172 patients with pre-heart failure (HF) or HF. We investigated (i) the relationship between B-lines and LV diastolic function using echocardiography, (ii) the diagnostic accuracy of B-lines compared to echocardiography indices for estimating LV filling pressures and (iii) the relationship between B-lines and risk of hospitalisation for HF.
Results:
Among patients for whom the ASE/EACVI guideline algorithm for LV diastolic dysfunction was available (n = 89), the number of B-lines typically increased with the severity of diastolic dysfunction grade. In patients who underwent left heart catheterisation (n = 20), the LV filling pressure was significantly correlated with B-lines (r = 0.690, P < 0.001). The diagnostic accuracy of B-lines for detecting high LV filling pressure was comparable to that of tricuspid regurgitation peak gradient (TRPG). When TRPG was replaced with B-lines to diagnose grade II or III diastolic dysfunction using the ASE/ESCVI algorithm, sensitivity remained comparable (0.80); however, specificity improved (0.80 vs. 0.50). In patients who underwent lung ultrasound while they were hemodynamically stable and were followed up for prognosis (median, 730 days; n = 75), 14 hospitalisations for HF were observed. Kaplan-Meier analysis revealed that the high B-line group had a significantly higher incidence of hospitalisation events for HF (P = 0.036, log-rank test).
Conclusion:
B-lines have shown potential as an alternative to conventional indices for assessing LV diastolic dysfunction.
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