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

Abstract

Øyvind Johannessen,1,2 Fride Uthaug Reite,3 Rahul Bhatnagar,1,2 Tarjei Øvrebotten,1,2 Gunnar Einvik,1,3,* Peder L Myhre1,2,* 1Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 2Department of Cardiology, Akershus University Hospital, Lørenskog, Norway; 3Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway*These authors contributed equally to this workCorrespondence: Peder L Myhre, Department of Cardiology, Akershus University Hospital, Lørenskog, 1478, Norway, Tel [phone], Email [email protected]: 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: chronic obstructive pulmonary disease, heart failure, lung ultrasound, acute exacerbations, pulmonary congestion, B-lines