Lung ultrasound to assess pulmonary congestion in patients with acute exacerbation of COPD - a feasibility study

BackgroundChronic heart failure (HF) coexist with chronic obstructive pulmonary disease (COPD) in approximately 25% of patients and is associated with worse outcomes. Lung ultrasound (LUS) is a validated technique to diagnose pulmonary congestion by detecting vertical lung artifacts, B-lines. Pulmonary inflammation is also associated with B-lines, but little is known about LUS in patients with acute exacerbation of COPD (AECOPD). AimsTo assess the feasibility of LUS to detect concurrent acute HF in AECOPD and examine the associations between B-lines, clinical parameters during hospitalization and re-hospitalizations and mortality. Methods & resultsIn a prospective cohort study 123 patients with AECOPD (age 75{+/-}9 years, 57 [46%] men) underwent 8-zone bedside LUS within 24h after admission. A positive LUS was defined by [≥]3 B-lines in [≥]2 zones bilaterally. A cardiologist committee blinded for LUS adjudicated whether concurrent HF was present (n=48, 39%). The median number of B-lines was 8 (IQR 5-13) and 16 (13%) patients had positive LUS. Positive LUS was associated with infiltrates on chest X-ray. The prevalence of positive LUS was similar with and without concurrent HF 8 (17%) vs 8 (11%), p=0.34, while 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 positive LUS to detect concurrent HF was 16.7% and 89.3%, respectively. Positive LUS was not associated with re-hospitalization and mortality: Adjusted HR 0.93 (0.49-1.75), p=0.81. ConclusionsLUS did not detect concurrent HF or predict risk in patients hospitalized with AECOPD.