Lung ultrasonography derived B-line scores as predictors of left ventricular end-diastolic pressure and pulmonary artery wedge pressure

Marcos V F Garcia; Jonathan Wiesen; Siddharth Dugar; Jacob R Adams; Corinne Bott-Silverman; Ajit Moghekar; Adriano R Tonelli

doi:10.1016/j.rmed.2023.107415

Lung ultrasonography derived B-line scores as predictors of left ventricular end-diastolic pressure and pulmonary artery wedge pressure

Respir Med. 2023 Nov-Dec:219:107415. doi: 10.1016/j.rmed.2023.107415. Epub 2023 Sep 22.

Authors

Marcos V F Garcia¹, Jonathan Wiesen², Siddharth Dugar³, Jacob R Adams⁴, Corinne Bott-Silverman⁵, Ajit Moghekar⁶, Adriano R Tonelli⁷

Affiliations

¹ Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA.
² University of Be'er Sheva, Soroka Hospital, Be'er-Sheva, Israel.
³ Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA; Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Adventist Health St. Helena, St. Helena, California, USA.
⁵ Heart & Vascular Institute, Cleveland Clinic Florida, Weston, FL, USA.
⁶ Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
⁷ Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: tonella@ccf.org.

PMID: 37741582
DOI: 10.1016/j.rmed.2023.107415

Abstract

Background: Non-invasive assessment of elevated left ventricular end-diastolic pressure (LVEDP) and pulmonary artery wedge pressure (PAWP) in patients with heart diseases is challenging. Lung ultrasonography (LUS) is a promising modality for predicting LVEDP and PAWP.

Methods: Fifty-seven stable ambulatory patients who underwent right and left heart catheterization were included. Following the procedures, LUS was performed in twenty-eight ultrasonographic zones, and the correlation between five different LUS derived B-line scores with LVEDP and PAWP was examined.

Results: The B-line index correlated with LVEDP and PAWP, with coefficients of 0.45 (p = 0.006) and 0.30 (p = 0.03), respectively. B-line index showed an AUC of 0.76 for identifying LVEDP > 15 mmHg (p = 0.01) and an AUC of 0.73 for identifying PAWP > 15 mmHg (p = 0.008). Overall, scores performances were similar in predicting LVEDP or PAWP > 15 mmHg. A B-line index ≥ 28 was significantly associated with LVEDP > 15 mmHg (OR: 9.97) and PAWP > 15 mmHg (OR: 6.61), adjusted for age and indication for heart catheterization.

Conclusions: LUS derived B-line scores are moderately correlated with PAWP and LVEDP in patients with heart diseases. A B-line index ≥ 28 can be used to predict elevated LVEDP and PAWP with high specificity.

Keywords: Left ventricular end-diastolic pressure; Lung ultrasonography; Pulmonary artery wedge pressure; Right heart catheterization.

MeSH terms

Blood Pressure
Cardiac Catheterization* / methods
Heart Diseases*
Humans
Lung / diagnostic imaging
Pulmonary Artery / diagnostic imaging
Pulmonary Wedge Pressure
Ultrasonography
Ventricular Function, Left