Interest of Lung Ultrasound in the Management of Acute Heart Failure in Post-Emergency Service

Lung ultrasound (LUS) has emerged as a simple, rapid, and non-invasive method for the dynamic assessment of pulmonary congestion, a major prognostic factor and a therapeutic target in acute heart failure (AHF). In a single-center prospective observational study, 42 patients hospitalized for AHF in the post-emergency polyvalent medicine department of CHU Grenoble were successively included between May 2021 and July 2022. Patients undergoing hemodialysis, those with pneumonectomy or lung fibrosis, or those placed under guardianship or deprived of freedom were excluded. Clinical examination, LUS, and electrolyte panel results were collected daily. Vital status was assessed 30 days after the last LUS. The primary endpoint was the evolution of the number of B-lines in relation to the dose of diuretic administered. Secondary endpoints included the evolution of B-lines according to clinical signs of congestion and plasma creatinine levels, the agreement between LUS and clinical findings at discharge, and the prognostic value of LUS at discharge for 30-day re-admission for AHF and all-cause mortality. A total of 188 LUS were performed. The patients were elderly (85.8 years [SD 8.1]) and comorbid. The median number of B-lines decreased from 17 at admission to 7 mid-hospitalization, then stabilized. The median daily intravenous diuretic dose declined from 40 mg to 20 mg. Patients with chronic kidney disease (CKD) had more B-lines at admission (24.2 (SD 11.6) vs. 8.2 (SD 8.8)). However, B-line evolution was independent of creatinine levels. Higher B-lines at discharge were significantly associated with 30-day mortality (15.2 vs. 3.9, <i>p</i> < 0.001). In the absence of a gold standard for the assessment of pulmonary congestion, LUS appears to be an additional tool for optimizing the management of AHF.