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Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF

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Lung ultrasound (LUS) can be used to assess pulmonary congestion by imaging B-lines (‘comets’) for patients with acute heart failure (AHF).


Investigate relationship of B-lines, plasma concentrations of B-type natriuretic peptide (BNP), and echocardiographic left ventricular (LV) function measured at admission and discharge and their relationship to prognosis for AHF with preserved (HFpEF) or reduced (HFrEF) LV ejection fraction.


Patients with AHF had the above tests done at admission and discharge. The primary outcome was re-hospitalization for heart failure or death at 6 months.


Of 162 patients enrolled, 95 had HFrEF and 67 had HFpEF, median age was 80 [77–85] years, and 85 (52%) were women. The number of B-lines at admission (median 31 [27–36]) correlated with respiratory rate (r = 0.75; p < 0.001), BNP (r = 0.43; p < 0.001), clinical congestion score (r = 0.25; p = 0.001), and systolic pulmonary artery pressure (r = 0.42; p < 0.001). At discharge, B-lines were also correlated with BNP (r = 0.69; p < 0.001) and congestion score (r = 0.57; p < 0.001). B-line count at discharge predicted outcome (AUC 0.83 [0.77–0.90]; univariate HR 1.12 [1.09–1.16]; p < 0.001; multivariable HR 1.16 [1.11–1.21]; p < 0.001). Results were similar for HFpEF and HFrEF.


LUS appears a useful method to assess severity and monitor the resolution of lung congestion. At hospital admission, B-lines are strongly related to respiratory rate, which may be a key component of the sensation of dyspnea. Measurement of lung congestion at discharge provides prognostic information for patients with either HFpEF or HFrEF.

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Acute heart failure


Atrial fibrillation


B-type natriuretic peptide


Deceleration time


Ejection fraction


Heart failure


Heart failure with preserved ejection fraction


Heart failure with reduced ejection fraction


Isovolumetric relaxation time


Lung ultrasound


Left ventricular


Natriuretic peptides


Systolic pulmonary artery pressure


Receiving operating characteristics


  1. Gheorghiade M, Zannad F, Sopko G, International Working Group on Acute Heart Failure Syndromes et al (2005) Acute heart failure syndromes: current state and framework for future research. Circulation 112:3958–3968

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Authors and Affiliations



AP and GR helped conceive and design the study and interpreted the results AP supervised the research and wrote the first draft of the manuscript. GR provided statistical analysis and revised the manuscript. MB helped acquire data. RN and JGC contributed to data interpretation and revision of the manuscript. All authors gave final approval of the version to be published.

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Correspondence to Alberto Palazzuoli.

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Conflict of interest

Dr. Palazzuoli, Ruocco, Beltrami, and Nuti report no relevant conflicts; Prof. J. G. Cleland has received research grants from Amgen, Novartis, and Stealth Biopharmaceuticals.

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Palazzuoli, A., Ruocco, G., Beltrami, M. et al. Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF. Clin Res Cardiol 107, 586–596 (2018).

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