Clinical Utility of Lung Ultrasound in the Diagnosis and Management of Acute Decompensated Heart Failure

Background: Acute decompensated heart failure (ADCHF) is a leading cause of hospitalization, and early diagnosis is crucial for optimizing management. Lung ultrasound (LUS) has emerged as a promising tool for detecting pulmonary congestion, but its accuracy compared to chest X-ray (CXR) and B-type natriuretic peptide (BNP) levels remains under evaluation. This study aimed to assess the utility of LUS in detecting pulmonary congestion and monitoring response to therapy in ADCHF. Additionally, the diagnostic accuracy of LUS was compared with CXR, and the correlation between B-lines on LUS and plasma BNP levels was evaluated. Methods: A prospective observational study was conducted on 200 patients presenting with breathlessness, palpitations, fatigue, and other heart failure symptoms. The diagnostic efficacy of CXR, BNP levels, and LUS was analysed using statistical methods, including chi-square tests and correlation analysis. Paired t-tests were used to compare changes in B-lines and BNP levels before and after diuretic therapy. A p-value <0.05 was considered statistically significant. Results: Among 200 patients, 168 (84.0%) were diagnosed with acute decompensated heart failure (ADCHF). Lung ultrasound, BNP levels, and chest X-ray demonstrated a statistically significant association with ADCHF (p < 0.0001). Lung ultrasound had a sensitivity of 90.5% and specificity of 87.5%, while BNP showed a sensitivity of 91.1% and specificity of 85.0%. Chest X-ray had a sensitivity of 76.2% and specificity of 81.3%. A strong correlation was observed between BNP levels and B-lines on lung ultrasound (ρ = 0.85, p < 0.0001). Post-diuretic therapy, the mean B-line count significantly decreased from 15.2 ± 1.12 to 6.2 ± 1.07 (p < 0.0001), and BNP levels declined from 682.8 ± 229.1 pg/ml to 101.1 ± 12.3 pg/ml (p < 0.0001), indicating effective decongestion. Conclusion: LUS demonstrated superior diagnostic accuracy compared to CXR and was strongly correlated with BNP levels in ADCHF patients. The significant reduction in B-lines and BNP levels post-diuretic therapy highlights the utility of LUS in monitoring therapeutic response. These findings support the broader adoption of LUS in the clinical evaluation and management of ADCHF.