Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Eur J Heart Fail. 2012 Nov;14(11):1276-84. doi: 10.1093/eurjhf/hfs144. Epub 2012 Sep 7.
Quantification of linear lung ultrasound (LUS) artefacts (B-lines) represents a novel, non-invasive approach to assess pulmonary congestion. We investigated the relationship between the number of B-lines (vertical artefacts arising from the pleural line) and intracardiac pressures.
Prior to scheduled right heart catheterization (RHC), 100 subjects underwent LUS of eight zones. A reviewer blinded to the haemodynamic data quantified the number of sonographic B-lines. Of 92 subjects who completed RHC, 79 had adequate LUS data of all zones [median age 61 years, 26 women, median left ventricular ejection fraction (LVEF) 58%, 35 with history of heart failure; 22 postcardiac transplantation]. The number of B-lines correlated with measured right atrial (r = 0.32), pulmonary artery diastolic (PADP) (r = 0.34), mean pulmonary artery (mPAP) (r = 0.43), pulmonary artery systolic (PASP) (r = 0.48) pressures, and pulmonary vascular resistance (PVR) (r = 0.51) (P < 0.005 for all), but not with pulmonary capillary wedge pressure. There was a graded association between tertiles of B-line number and increasing PADP, mPAP, PASP, and PVR (P for trend ≤0.001 for all). Each additional B-line was associated with an increase in PASP of 1 mmHg and an increase in PVR of 0.1 Wood units. These associations remained robust after multivariable adjustment (P = 0.002). Assessment of two inferior lateral zones resulted in similar correlations to the eight-zone method.
Easily obtainable, LUS may be useful in the estimation of right-sided cardiac pressures and PVR. Further evaluation of lung ultrasound as an adjunct to heart failure diagnosis, monitoring, and prognosis is warranted.
线性肺部超声（LUS）伪像（B 线）的量化代表了一种新的、非侵入性的评估肺充血的方法。我们研究了 B 线数量（源于胸膜线的垂直伪像）与心内压之间的关系。
在计划进行右心导管检查（RHC）之前，100 例患者接受了 8 个区域的 LUS 检查。一位对血流动力学数据不知情的审查员对超声 B 线的数量进行了量化。在完成 RHC 的 92 例患者中，79 例患者的所有区域均有足够的 LUS 数据[中位数年龄 61 岁，26 例女性，左心室射血分数（LVEF）中位数 58%，35 例有心力衰竭史；22 例心脏移植后]。B 线数量与测量的右心房（r = 0.32）、肺动脉舒张末期压（PADP）（r = 0.34）、肺动脉平均压（mPAP）（r = 0.43）、肺动脉收缩压（PASP）（r = 0.48）和肺血管阻力（PVR）（r = 0.51）相关（所有 P < 0.005），但与肺毛细血管楔压无关。B 线数量的三分位与 PADP、mPAP、PASP 和 PVR 的增加呈梯度相关（所有 P 趋势值 < 0.001）。每增加一条 B 线，PASP 增加 1mmHg，PVR 增加 0.1 Wood 单位。这些关联在多变量调整后仍然稳健（P = 0.002）。对两个下外侧区域的评估与 8 区域方法产生了类似的相关性。
易于获得的 LUS 可能有助于估计右侧心脏压力和 PVR。进一步评估肺部超声作为心力衰竭诊断、监测和预后的辅助手段是必要的。
