Platz Elke, McDowell Kirsty, Gupta Deepak K, Claggett Brian, Brennan Alice, Charles Lawrence J, Cunningham Jonathan W, Dixon Debra D, Docherty Kieran F, Jering Karola, Oggs Rashundra, Palacios Julia, Schwede Madeleine, Ravi Katherine Scovner, Sukumar Shivasankar M, Wassenaar Jean W, Lewis Eldrin F, McMurray John J V, Campbell Ross T
Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK.
J Card Fail. 2025 Mar 5. doi: 10.1016/j.cardfail.2025.02.013.
Early detection of pulmonary congestion among ambulatory patients with heart failure with preserved ejection fraction (HFpEF) is critical to optimize decongestive therapy before overt decompensation, yet traditional tools are insensitive. We sought to examine the prevalence of B-lines, an ultrasound measure of pulmonary congestion, and their clinical and imaging correlates in patients with HFpEF.
In a prospective, multisite observational study, using a pocket ultrasound device, 8-zone lung ultrasound examination was performed in outpatients with HFpEF, left ventricular ejection fraction (LVEF) of ≥45% and New York Heart Association functional class II through IV. B-lines and cardiac structure and function from echocardiograms were quantified off-line in core laboratories, blinded to clinical findings. Among 415 participants (mean age 74 years, 52% women, 51% obese, median N-terminal pro-B-type natriuretic peptide [NT-proBNP] 744 pg/mL) B-lines were detectable in 78% of patients ranging from 0 to 36 (median 3, interquartile range 1-6). There was a linear association between B-line count and log-transformed NT-proBNP (P < .001). Among patients in the highest tertile of B-lines, 76% had no crackles on auscultation, and 50% did not have elevated NT-proBNP levels. A higher B-line count was associated with larger sizes of cardiac chambers, greater left ventricular mass, higher filling pressures (E/e'), tricuspid regurgitant velocity, and inferior vena cava size, and worse right ventricular systolic function (P for trend < .05 for all), but not left ventricular ejection fraction.
Among ambulatory patients with HFpEF, lung ultrasound-detected B-lines were common, associated with NT-proBNP levels and clinically important echocardiographic features, and identified pulmonary congestion that was not always evident by auscultation.
对于射血分数保留的心力衰竭（HFpEF）门诊患者，早期发现肺充血对于在明显失代偿前优化去充血治疗至关重要，但传统工具不够敏感。我们试图研究B线（一种肺充血的超声测量指标）的患病率及其在HFpEF患者中的临床和影像学相关性。
在一项前瞻性、多中心观察性研究中，使用便携式超声设备，对HFpEF、左心室射血分数（LVEF）≥45%且纽约心脏协会功能分级为II至IV级的门诊患者进行8区肺部超声检查。在核心实验室对超声心动图中的B线以及心脏结构和功能进行离线定量分析，分析人员对临床结果不知情。在415名参与者（平均年龄74岁，52%为女性，51%肥胖，N末端B型利钠肽原[NT-proBNP]中位数为744 pg/mL）中，78%的患者可检测到B线，数量范围为0至36条（中位数为3条，四分位间距为1 - 6条）。B线计数与经对数转换的NT-proBNP之间存在线性关联（P < .001）。在B线处于最高三分位数的患者中，76%的患者听诊时无啰音，50%的患者NT-proBNP水平未升高。较高的B线计数与较大的心脏腔室大小、更大的左心室质量、更高的充盈压（E/e'）、三尖瓣反流速度和下腔静脉大小以及更差 的右心室收缩功能相关（所有趋势P < .05），但与左心室射血分数无关。
在HFpEF门诊患者中，肺部超声检测到的B线很常见，与NT-proBNP水平及重要的超声心动图特征相关，并可发现听诊时并不总是明显的肺充血。
