Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Eur J Heart Fail. 2017 Sep;19(9):1154-1163. doi: 10.1002/ejhf.839. Epub 2017 May 30.
Pulmonary congestion is an important finding in patients with heart failure (HF) that can be quantified by lung ultrasound (LUS). We conducted a systematic review to describe dynamic changes in LUS findings of pulmonary congestion (B-lines) in HF and to examine the prognostic utility of B-lines in HF.
We searched online databases for studies conducted in patients with chronic or acute HF that used LUS to assess dynamic changes or the prognostic value of pulmonary congestion. We included studies in adult populations, published in English, and conducted in ≥25 patients. Of 1327 identified studies, 13 (25-290 patients) met the inclusion criteria: six reported on dynamic changes in LUS findings (438 patients) and seven on the prognostic value of B-lines in HF (953 patients). In acute HF, B-line number changed within as few as 3 h of HF treatment. In acute HF, ≥15 B-lines on 28-zone LUS at discharge identified patients at a more than five-fold risk for HF readmission or death. Similarly, in ambulatory patients with chronic HF, ≥3 B-lines on five- or eight-zone LUS marked those at a nearly four-fold risk for 6-month HF hospitalization or death.
Lung ultrasound findings change rapidly in response to HF therapy. This technique may represent a useful and non-invasive method to track dynamic changes in pulmonary congestion. Furthermore, residual congestion at the time of discharge in acute HF or in ambulatory patients with chronic HF may identify those at high risk for adverse events.
肺部充血是心力衰竭（HF）患者的重要表现，可以通过肺部超声（LUS）进行量化。我们进行了一项系统评价，以描述 HF 患者肺部充血（B 线）的 LUS 发现的动态变化，并研究 B 线在 HF 中的预后价值。
我们在在线数据库中搜索了使用 LUS 评估肺部充血动态变化或 B 线在 HF 中预后价值的慢性或急性 HF 患者的研究。我们纳入了成年人群的研究，发表在英文期刊上，且纳入患者数≥25 例。在 1327 项确定的研究中，有 13 项（25-290 例患者）符合纳入标准：6 项研究报告了 LUS 发现的动态变化（438 例患者），7 项研究报告了 B 线在 HF 中的预后价值（953 例患者）。在急性 HF 中，HF 治疗后仅 3 h 内 B 线数量就发生了变化。在急性 HF 中，出院时 28 区 LUS 上≥15 条 B 线可使 HF 再入院或死亡的风险增加五倍以上。同样，在慢性 HF 的门诊患者中，5 区或 8 区 LUS 上≥3 条 B 线可使 6 个月 HF 住院或死亡的风险增加近四倍。
肺部超声发现可迅速响应 HF 治疗而变化。该技术可能代表了一种有用的、非侵入性的方法，可以追踪肺部充血的动态变化。此外，急性 HF 患者出院时或慢性 HF 门诊患者仍存在充血可能提示预后不良的风险较高。
