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Serial Sonographic Assessment of Pulmonary Edema in Patients With Hypertensive Acute Heart Failure
Author(s) -
Martindale Jennifer L.,
Secko Michael,
Kilpatrick John F.,
deSouza Ian S.,
Paladino Lorenzo,
Aherne Andrew,
Mehta Ninfa,
Conigiliaro Alyssa,
Sinert Richard
Publication year - 2018
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14336
Subject(s) - medicine , interquartile range , pulmonary edema , edema , heart failure , lung , visual analogue scale , cardiology , triage , radiology , anesthesia , emergency medicine
Objectives Objective measures of clinical improvement in patients with acute heart failure (AHF) are lacking. The aim of this study was to determine whether repeated lung sonography could semiquantitatively capture changes in pulmonary edema (B‐lines) in patients with hypertensive AHF early in the course of treatment. Methods We conducted a feasibility study in a cohort of adults with acute onset of dyspnea, severe hypertension in the field or at triage (systolic blood pressure ≥ 180 mm Hg), and a presumptive diagnosis of AHF. Patients underwent repeated dyspnea and lung sonographic assessments using a 10‐cm visual analog scale (VAS) and an 8‐zone scanning protocol. Lung sonographic assessments were performed at the time of triage, initial VAS improvement, and disposition from the emergency department. Sonographic pulmonary edema was independently scored offline in a randomized and blinded fashion by using a scoring method that accounted for both the sum of discrete B‐lines and degree of B‐line fusion. Results Sonographic pulmonary edema scores decreased significantly from initial to final sonographic assessments ( P < .001). The median percentage decrease among the 20 included patient encounters was 81% (interquartile range, 55%–91%). Although sonographic pulmonary edema scores correlated with VAS scores (ρ = 0.64; P < .001), the magnitude of the change in these scores did not correlate with each other (ρ = –0.04; P = .89). Conclusions Changes in sonographic pulmonary edema can be semiquantitatively measured by serial 8‐zone lung sonography using a scoring method that accounts for B‐line fusion. Sonographic pulmonary edema improves in patients with hypertensive AHF during the initial hours of treatment.