TY - JOUR

T1 - B-lines with Lung Ultrasound

T2 - The Optimal Scan Technique at Rest and During Stress

AU - Stress Echo 2020 study group of the Italian Society of Cardiovascular Echography

AU - Scali, Maria Chiara

AU - Zagatina, Angela

AU - Simova, Iana

AU - Zhuravskaya, Nadezhda

AU - Ciampi, Quirino

AU - Paterni, Marco

AU - Marzilli, Mario

AU - Carpeggiani, Clara

AU - Picano, Eugenio

AU - Citro, Rodolfo

AU - D'Andrea, Antonello

AU - Cortigiani, Lauro

AU - Olivotto, Iacopo

AU - Mori, Fabio

AU - Galderisi, Maurizio

AU - Costantino, Marco Fabio

AU - Pratali, Lorenza

AU - di Salvo, Giovanni

AU - Bossone, Eduardo

AU - Ferrara, Francesco

AU - Kasprszak, Jaroslaw D.

AU - Rigo, Fausto

AU - Gaibazzi, Nicola

AU - Limongelli, Giuseppe

AU - Pacileo, Giuseppe

AU - Severino, Sergio

AU - Pinamonti, Bruno

AU - Massa, Laura

AU - Torres, Marco A.R.

AU - Miglioranza, Marcelo H.

AU - Daros, Clarissa Borguezan

AU - Luis de Castro e Silva Pretto, José

AU - Djordjevic-Dikic, Ana

AU - Dekleva, Milica

AU - Varga, Albert

AU - Agoston, Gergely

AU - Palinkas, Attila

AU - Amor, Miguel

AU - Lowenstein, Jorge

AU - Merlo, Pablo

AU - Celutkiene, Jelena

AU - Perez, Julio E.

AU - Trambaiolo, Paolo

AU - Gregori, Dario

AU - Colonna, Paolo

AU - Andreassi, Maria Grazia

AU - De Nes, Michele

AU - Arystan, Ayana

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Various lung ultrasound (LUS) scanning modalities have been proposed for the detection of B-lines, also referred to as ultrasound lung comets, which are an important indication of extravascular lung water at rest and after exercise stress echo (ESE). The aim of our study was to assess the lung water spatial distribution (comet map) at rest and after ESE. We performed LUS at rest and immediately after semi-supine ESE in 135 patients (45 women, 90 men; age 62 ± 12 y, resting left ventricular ejection fraction = 41 ± 13%) with known or suspected heart failure or coronary artery disease. B-lines were measured by scanning 28 intercostal spaces (ISs) on the antero-lateral chest, 2nd–5th IS, along with the midaxillary (MA), anterior axillary (AA), mid-clavicular (MC) and parasternal (PS) lines. Complete 28-region, 16-region (3rd and 4th IS), 8-region (3rd IS), 4-region (3rd IS, only AA and MA) and 1-region (left 3rd IS, MA) scans were analyzed. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. Interpretable images were obtained in all spaces (feasibility = 100 %). B-lines (>0 in at least 1 space) were present at ESE in 93 patients (69%) and absent in 42. More B-lines were found in the 3rd IS and along AA and MA lines. The B-line cumulative distribution was symmetric at rest (right/left = 1.10) and asymmetric with left lung predominance during stress (right/left = 0.67). The correlation of per-patient B-line number between 28-S and 16-S (R2 = 0.9478), 8-S (R2 = 0.9478) and 4-S scan (R2 = 0.9146) was excellent, but only good with 1-S (R2 = 0.8101). The average imaging and online analysis time were 5 s per space. In conclusion, during ESE, the comet map of lung water accumulation follows a predictable spatial pattern with wet spots preferentially aligned with the third IS and along the AA and MA lines. The time-saving 4-region scan is especially convenient during stress, simply dismissing dry regions and focusing on wet regions alone.

AB - Various lung ultrasound (LUS) scanning modalities have been proposed for the detection of B-lines, also referred to as ultrasound lung comets, which are an important indication of extravascular lung water at rest and after exercise stress echo (ESE). The aim of our study was to assess the lung water spatial distribution (comet map) at rest and after ESE. We performed LUS at rest and immediately after semi-supine ESE in 135 patients (45 women, 90 men; age 62 ± 12 y, resting left ventricular ejection fraction = 41 ± 13%) with known or suspected heart failure or coronary artery disease. B-lines were measured by scanning 28 intercostal spaces (ISs) on the antero-lateral chest, 2nd–5th IS, along with the midaxillary (MA), anterior axillary (AA), mid-clavicular (MC) and parasternal (PS) lines. Complete 28-region, 16-region (3rd and 4th IS), 8-region (3rd IS), 4-region (3rd IS, only AA and MA) and 1-region (left 3rd IS, MA) scans were analyzed. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. Interpretable images were obtained in all spaces (feasibility = 100 %). B-lines (>0 in at least 1 space) were present at ESE in 93 patients (69%) and absent in 42. More B-lines were found in the 3rd IS and along AA and MA lines. The B-line cumulative distribution was symmetric at rest (right/left = 1.10) and asymmetric with left lung predominance during stress (right/left = 0.67). The correlation of per-patient B-line number between 28-S and 16-S (R2 = 0.9478), 8-S (R2 = 0.9478) and 4-S scan (R2 = 0.9146) was excellent, but only good with 1-S (R2 = 0.8101). The average imaging and online analysis time were 5 s per space. In conclusion, during ESE, the comet map of lung water accumulation follows a predictable spatial pattern with wet spots preferentially aligned with the third IS and along the AA and MA lines. The time-saving 4-region scan is especially convenient during stress, simply dismissing dry regions and focusing on wet regions alone.

KW - Exercise

KW - Lung

KW - Stress

KW - Water

UR - http://www.scopus.com/inward/record.url?scp=85028509536&partnerID=8YFLogxK

U2 - 10.1016/j.ultrasmedbio.2017.07.007

DO - 10.1016/j.ultrasmedbio.2017.07.007

M3 - Article

C2 - 28865726

AN - SCOPUS:85028509536

VL - 43

SP - 2558

EP - 2566

JO - Ultrasound in Medicine and Biology

JF - Ultrasound in Medicine and Biology

SN - 0301-5629

IS - 11

ER -