Skip to main content
SpringerLink
Log in

A practical guide to the lung ultrasound for the assessment of congestive heart failure

  • Review Article
  • Published:
Journal of Echocardiography Aims and scope Submit manuscript

Abstract

Dyspnea is one of the major symptoms encountered in the emergency department, and lung ultrasound (LUS) is recommended for the rapid diagnosis of the underlying disease. B-lines, the “comet-tail”-like vertical lines moving with respiration, are an ultrasound finding relevant to the pulmonary congestion. They may be observed in the normal lung, but bilateral, ≥ 3 B-lines are considered pathological. B-lines with lung sliding (B profile) are a specific sign of heart failure, while B-lines with abolished lung sliding (B’ profile) are related with the lung diseases such as acute respiratory distress syndrome. B profile is reported to detect pulmonary edema with about 95% sensitivity and 95% specificity in patients with dyspnea. LUS also can assess the severity of pulmonary congestion semi-quantitatively by counting the number of B-lines or that of positive areas. Whereas the original BLUE protocol requires scanning at 12 zones on the chest, more rapid 8- or 6-zone scan is sufficient for the diagnosis of heart failure, and 2- or 4-zone scan may be used for the critical patients. LUS may be used for the evaluation of heart failure treatment, or can be performed as a part of exercise stress test. LUS can be performed easily and rapidly at the bedside using almost any kind of ultrasound apparatus, and it should be performed more widely in the daily practice as well as in the emergent department.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kelly AM, Keijzers G, Klim S, et al. An observational study of dyspnea in emergency departments: the Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). Acad Emerg Med. 2017;24:328–36.

    Article  Google Scholar 

  2. Matsue Y, Damman K, Voors AA, et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. J Am Coll Cardiol. 2017;69:3042–51.

    Article  Google Scholar 

  3. Kobayashi M, Douair A, Duarte K, et al. Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort. PLoS Med. 2020;17:1–17.

    Article  Google Scholar 

  4. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:891–975.

    Article  Google Scholar 

  5. Mebazaa A, Yilmaz MB, Levy P, et al. Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emerge. Eur Heart J. 2015;36:1958–66.

    Article  Google Scholar 

  6. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577–91.

    Article  Google Scholar 

  7. Jambrik Z, Monti S, Coppola V, et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water [Internet]. Am J Cardiol Am J Cardiol. 2004;93:1265–70.

    Article  Google Scholar 

  8. Agricola E, Bove T, Oppizzi M, Marino G, et al. “Ultrasound comet-tail images”: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest. 2005;127:1690–5.

    Article  Google Scholar 

  9. Frasure SE, Matilsky DK, Siadecki SD, Platz E, Saul T, Lewiss RE. Impact of patient positioning on lung ultrasound findings in acute heart failure. Eur Heart J Acute Cardiovasc Care. 2015;4:326–32.

    Article  Google Scholar 

  10. Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure the BLUE protocol. Chest. 2008;134:117–25.

    Article  Google Scholar 

  11. Volpicelli G. Sonographic diagnosis of pneumothorax. Intensive Care Med. 2011;37:224–32.

    Article  Google Scholar 

  12. Copetti R, Soldati G, Copetti P. Chest sonography: A useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;6:16. https://doi.org/10.1186/1476-7120-6-16.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gargani L, Volpicelli G. How I do it: Lung ultrasound. Cardiovasc Ultrasound. 2014;12:1–10.

    Article  Google Scholar 

  14. Sekiguchi H, Schenck LA, Horie R, et al. Critical care ultrasonography differentiates ARDS, pulmonary edema, and other causes in the early course of acute hypoxemic respiratory failure. Chest. 2015;148:912–8.

    Article  Google Scholar 

  15. Liteplo AS, Marill KA, Villen T, et al. Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): Sonographic B-lines and N-terminal Pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med. 2009;16:201–10.

    Article  Google Scholar 

  16. Pivetta E, Goffi A, Lupia E, et al. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest. 2015;148:202–10.

    Article  Google Scholar 

  17. Platz E, Jhund PS, Girerd N, et al. Expert consensus document: Reporting checklist for quantification of pulmonary congestion by lung ultrasound in heart failure. Eur J Heart Fail. 2019;21:844–51.

    Article  Google Scholar 

  18. Platz E, Campbell RT, Claggett B, et al. Lung ultrasound in acute heart failure: prevalence of pulmonary congestion and short- and long-term outcomes. JACC Hear Fail. 2019;7:849–58.

    Article  Google Scholar 

  19. Buessler A, Chouihed T, Duarte K, et al. Accuracy of several lung ultrasound methods for the diagnosis of acute heart failure in the ED: a multicenter prospective study. Chest. 2020;157:99–110.

    Article  Google Scholar 

  20. Miglioranza MH, Gargani L, Sant’Anna RT, et al. Lung ultrasound for the evaluation of pulmonary congestion in outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography. JACC Cardiovasc Imaging. 2013;6:1141–51.

    Article  Google Scholar 

  21. McGivery K, Atkinson P, Lewis D, et al. Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: A systematic review and meta-analysis. Can J Emerg Med. 2018;20:343–52.

    Article  Google Scholar 

  22. Maw AM, Hassanin A, Ho PM, McInnes MDF, Moss A, Juarez-Colunga E, et al. Diagnostic accuracy of point-of-care lung ultrasonography and chest radiography in adults with symptoms suggestive of acute decompensated heart failure: a systematic review and meta-analysis. jAMA Netw open. 2019;2:e190703.

    Article  Google Scholar 

  23. Tsutsui H, Isobe M, Ito H, et al. JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure—digest version -. Circ J. 2019;83:2084–184.

    Article  Google Scholar 

  24. Platz E, Merz AA, Jhund PS, et al. Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. Eur J Heart Fail. 2017;19:1154–63.

    Article  Google Scholar 

  25. Cortellaro F, Ceriani E, Spinelli M, et al. Lung ultrasound for monitoring cardiogenic pulmonary edema. Intern Emerg Med. 2017;12:1011–7.

    Article  Google Scholar 

  26. Rivas-Lasarte M, Maestro A, Fernández-Martínez J, et al. Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure. ESC Hear Fail. 2020;7:2621–8.

    Article  Google Scholar 

  27. Rivas-Lasarte M, Álvarez-García J, Fernández-Martínez J, et al. Lung ultrasound-guided treatment in ambulatory patients with heart failure: a randomized controlled clinical trial (LUS-HF study). Eur J Heart Fail. 2019;21:1605–13.

    Article  CAS  Google Scholar 

  28. Scali MC, Cortigiani L, Simionuc A, et al. Exercise-induced B-lines identify worse functional and prognostic stage in heart failure patients with depressed left ventricular ejection fraction. Eur J Heart Fail. 2017;19:1468–78.

    Article  CAS  Google Scholar 

  29. Platz E, Merz A, Silverman M, et al. Association between lung ultrasound findings and invasive exercise haemodynamics in patients with undifferentiated dyspnoea. ESC Hear Fail. 2019;6:202–7.

    Article  Google Scholar 

  30. Picano E, Ciampi Q, Wierzbowska-Drabik K, et al. The new clinical standard of integrated quadruple stress echocardiography with ABCD protocol. Cardiovasc Ultrasound. 2018;16:1–12.

    Article  Google Scholar 

Download references

Acknowledgements

We used royalty-free images downloaded from NATOM IMAGES ©Callimedia (http://med.astrazeneca.co.jp/medical/download/illustbank/generalized.html) for the body images in Figs. 3 and 5.

Author information

Authors and Affiliations

  1. Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan

    Katsuomi Iwakura & Toshinari Onishi

Authors
  1. Katsuomi Iwakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshinari Onishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katsuomi Iwakura.

Ethics declarations

Conflict of Interest

Katsuomi Iwakura and Toshinari Onishi declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iwakura, K., Onishi, T. A practical guide to the lung ultrasound for the assessment of congestive heart failure. J Echocardiogr 19, 195–204 (2021). https://doi.org/10.1007/s12574-021-00528-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12574-021-00528-7

Keywords

Search

Navigation