The assessment, interpretation and implementation of lung ultrasound examinations in Heart Failure: Current evidence and gaps in knowledge

• Published in: European journal of internal medicine 2024-12, Vol.130, p.52-61
• Main Authors: Palazzuoli, Alberto, Beltrami, Matteo, Girerd, Nicolas, Maw, Anna, Ruocco, Gaetano, Platz, Elke
• Format: Article
• Language: English
• Subjects: B-line; Congestion; Echocardiography; Heart failure; Heart Failure - diagnostic imaging; Humans; Lung - diagnostic imaging; Lung ultrasound; Pulmonary Edema - diagnostic imaging; Training strategies; Ultrasonography
• ISSN: 0953-6205; 1879-0828; 1879-0828
• DOI: 10.1016/j.ejim.2024.09.013

•Pulmonary congestion detected by LUS demonstrate an additional diagnostic and prognostic value when standardized imaging protocols and B-line quantification methods are being used.•The combination of echocardiographic and pulmonary features identifies patients at higher risk for worse outcomes, potentially facilitating both acute and chronic HF specific management and prognostic stratification.•Appropriate training on how to acquire and interpret LUS images within the clinical context is pivotal and can be accomplished through departmental implementation programs. Lung ultrasound (LUS) is a simple, fast and non-invasive tool for pulmonary congestion assessment with higher accuracy for the detection of acute heart failure (HF) compared to clinical examination and chest radiography. The integrated assessment with other ultrasound and echocardiographic parameters can lead to a better systemic and pulmonary congestion characterization. Additionally, the combination of echocardiographic and pulmonary features can identify patients at higher risk for adverse outcomes, potentially facilitating both acute and chronic HF management and prognostic stratification. However, the optimal utilization of LUS needs to be better defined both in terms of imaging method and B-line thresholds which may differ based on the clinical scenario and, potentially, the HF phenotype. Despite the extensive potential role of LUS in a wide range of HF scenarios, clinicians may be unaware of the correct technique and exam interpretation. Specifically, the interpretation of LUS findings is influenced by several factors, such as imaging protocol, type of ultrasound transducer, patient positioning, and presence of concomitant pulmonary diseases. The aim of this review is to provide a practical overview of LUS in patients with known or suspected HF with the goal of providing a practical guide for clinicians and nurses in various clinical settings.