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. 2023 Apr 25:18:693-703.
doi: 10.2147/COPD.S396855. eCollection 2023.

Lung Ultrasound to Assess Pulmonary Congestion in Patients with Acute Exacerbation of COPD

Øyvind Johannessen  1   2 , Fride Uthaug Reite  3 , Rahul Bhatnagar  1   2 , Tarjei Øvrebotten  1   2 , Gunnar Einvik #  1   3 , Peder L Myhre #  1   2
Affiliations

Lung Ultrasound to Assess Pulmonary Congestion in Patients with Acute Exacerbation of COPD

Øyvind Johannessen et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Heart failure (HF) often coexists with chronic obstructive pulmonary disease (COPD) and is associated with worse outcomes. We aimed to assess the feasibility of detecting vertical artifacts (B-lines) on lung ultrasound (LUS) to identify concurrent HF in patients hospitalized with acute exacerbation of COPD (AECOPD). Second, we wanted to assess the association between B-lines and the risk of rehospitalization for AECOPD or death.

Patients and methods: In a prospective cohort study, 123 patients with AECOPD underwent 8-zone bedside LUS within 24h after admission. A positive LUS was defined by ≥3 B-lines in ≥2 zones bilaterally. The ability to detect concurrent HF (adjudicated by a cardiologist committee) and association with events were evaluated by logistic- and Cox regression models.

Results: Forty-eight of 123 patients with AECOPD (age 75±9 years, 57[46%] men) had concurrent HF. Sixteen (13%) patients had positive LUS, and the prevalence of positive LUS was similar between patients with and without concurrent HF (8[17%] vs 8[11%], respectively, p=0.34). The number of B-lines was higher in concurrent HF: median 10(IQR 6-16) vs 7(IQR 5-12), p=0.03. The sensitivity and specificity for a positive LUS to detect concurrent HF were 17% and 89%, respectively. Positive LUS was not associated with rehospitalization and mortality: Adjusted HR: 0.93(0.49-1.75), p=0.81.

Conclusion: LUS did not detect concurrent HF or predict risk in patients with AECOPD.

Keywords: B-lines; acute exacerbations; chronic obstructive pulmonary disease; heart failure; lung ultrasound; pulmonary congestion.

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Conflict of interest statement

Dr. Johannessen has received grants from the Norwegian Society of Pulmonary Physicians, The Norwegian Society for Ultrasound in General Practice, and Astra-Zeneca via the Norwegian Society of Pulmonary Physicians. Dr. Einvik has received grants from the Norwegian Society of Pulmonary Physicians outside of the submitted work. Dr. Myhre is supported by research grants from the South-Eastern Norway Regional Health Authority and has served on advisory boards and consulted for Amarin, AmGen, AstraZeneca, Bayer, Boehringer-Ingelheim, Novartis and Novo Nordisk outside of the submitted work. All other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of the study population.
Figure 2
Figure 2
Clinical characteristics and findings in association with the total number of B-lines on lung ultrasound (LUS). Presented as a coefficient plot with incidence rate ratio and 95% confidence intervals.
Figure 3
Figure 3
Survival plots for rehospitalization and all-cause mortality in patients with and without a positive lung ultrasound (LUS) during the index hospitalization for acute exacerbation of chronic obstructive pulmonary disorder (AECOPD).
See this image and copyright information in PMC

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