Lung ultrasound guided management in chronic heart failure: an updated systematic review and meta-analysis of...

Existing systematic reviews support the prognostic and therapeutic value of lung ultrasound (LUS) in heart failure (HF), but recent randomized controlled trials (RCTs) in chronic HF justify an up-to-date synthesis.

A systematic search of OVID via Medline, SCOPUS, COCHRANE, and CINAHL was conducted from inception until 25 February 2025. The study was registered with PROSPERO (ID: CRD420251003434). RCTs of LUS interventions in patients with chronic HF were included. The primary outcomes were HF urgent visits and HF hospitalizations. Secondary outcomes included mortality, hypokalaemia, and worsening renal function. Five RCTs, involving a total of 694 patients, were included in meta-analyses, with variability in LUS-based definitions of pulmonary congestion across studies. LUS-guided management was associated with a significant reduction in HF urgent visits [RR 0.31 (95% CI 0.17, 0.55), I² = 0%] and a nonsignificant improvement in HF hospitalizations [RR 0.76 (95% CI 0.48, 1.18), I² = 38.9%]. There was no difference in the rates of mortality, hypokalaemia, or worsening renal function.

LUS-guided management is associated with a significant reduction in urgent HF visits and a nonsignificant reduction in HF hospitalizations, with no difference in rates of mortality, hypokalaemia, or worsening renal function. Future studies should aim to establish an optimal, standardized LUS-based definition of pulmonary congestion in chronic HF.