Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography.

Scali, Maria Chiara; Zagatina, Angela; Ciampi, Quirino; Cortigiani, Lauro; D'Andrea, Antonello; Daros, Clarissa Borguezan; Zhuravskaya, Nadezhda; Kasprzak, Jaroslaw D; Wierzbowska-Drabik, Karina; Luis de Castro E Silva Pretto, José; Djordjevic-Dikic, Ana; Beleslin, Branko; Petrovic, Marija; Boskovic, Nikola; Tesic, Milorad; Monte, Ines; Simova, Iana; Vladova, Martina; Boshchenko, Alla; Vrublevsky, Alexander; Citro, Rodolfo; Amor, Miguel; Vargas Mieles, Paul E; Arbucci, Rosina; Merlo, Pablo Martin; Lowenstein Haber, Diego M; Dodi, Claudio; Rigo, Fausto; Gligorova, Suzana; Dekleva, Milica; Severino, Sergio; Lattanzi, Fabio; Morrone, Doralisa; Galderisi, Maurizio; Torres, Marco A R; Salustri, Alessandro; Rodrìguez-Zanella, Hugo; Costantino, Fabio Marco; Varga, Albert; Agoston, Gergely; Bossone, Eduardo; Ferrara, Francesco; Gaibazzi, Nicola; Celutkiene, Jelena; Haberka, Maciej; Mori, Fabio; D'Alfonso, Maria Grazia; Reisenhofer, Barbara; Camarozano, Ana Cristina; Miglioranza, Marcelo Haertel; Szymczyk, Ewa; Wejner-Mik, Paulina; Wdowiak-Okrojek, Katarzyna; Preradovic-Kovacevic, Tamara; Bombardini, Tonino; Ostojic, Miodrag; Nikolic, Aleksandra; Re, Federica; Barbieri, Andrea; Di Salvo, Giovanni; Merli, Elisa; Colonna, Paolo; Lorenzoni, Valentina; De Nes, Michele; Paterni, Marco; Carpeggiani, Clara; Lowenstein, Jorge; Picano, Eugenio

OBJECTIVES The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). BACKGROUND B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. METHODS The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up. RESULTS According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction. CONCLUSIONS Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020 - The International Stress Echo Study [SE2020]; NCT03049995).