From: Clinical review: The role of ultrasound in estimating extra-vascular lung water
Study | Patient group | Ultrasound exam technique | Comparator | Conclusion |
---|---|---|---|---|
Lichtenstein and Meziere [34] | Acutely dyspnoeic patients (n = 66) | 3.0 MHz cardiac transducer Anterior - area bound by clavicle to diaphragm and sternum to AAL Lateral - area bound by armpit to diaphragm and AAL to PAL | Clinical, radiological, Echo | B-line artefact was seen in 100% of patients with pulmonary oedema and absent in 92% patients with COPD and 98.75% patients with normal lungs |
Lichtenstein and Meziere [41] | Acutely dyspnoeic patients (n = 260) | 5 MHz microconvex transducer 6 sites in each hemithorax divided in anterior, lateral and posterolateral | NA | Lung ultrasound can reliably distinguish asthma, COPD, oedema, pulmonary embolism, pneumothorax and consolidation |
Jambrik et al. [26] | Cardiology/ pneumonology (n = 121) | 2.5 to 3.5 MHz cardiac transducer 2nd to 4th ICS in left hemithorax (to 5th ICS on the right) at parasternal, midclavicular, AAL, PAL | Chest X-ray | Strong co-relation between B-line count and radiological lung water score (r = 0.78, P < 0.01) |
Agricola et al. [37] | Cardiology (n = 72) | 1.8 to 3.6 MHz transducer 2nd to 4th ICS in left hemithorax (to 5th ICS on the right) at parasternal, midclavicular, AAL, PAL | Echo (LV systolic function, PCWP, PAP) | Positive linear correlations between baseline B-line count and baseline ejection fraction, sPAP and estimated PCWP. A similar co-relation of the difference between post-exercise and baseline B-line count with indices of LV systolic and diastolic dysfunction |
Frassi et al. [39] | Cardiology (n = 290) | 2.5 to 3.5 MHz transducer 2nd to 4th ICS in left hemithorax (to 5th ICS on the right) at parasternal, midclavicular, AAL, PAL | Echo | Absence or presence of B-line predicted event-free survival (70% versus 19%, P < 0.0007) |
Frassi et al. [38] | Chest pain/dyspnoea patients (n = 340) | 2.5 to 3.5 MHz transducer 2nd to 4th ICS in left hemithorax (to 5th ICS on the right) at parasternal, midclavicular, AAL, PAL | Echo | B-lines associated with acute cardiac failure, response to treatment, EDV, LA dimension, MR, TR (P < 0.0001). In multivariate analysis NYHA functional class, EF and diastolic dysfunction predicted the presence of B-line |
Gargani et al. [40] | Dyspnoea patients (n = 149) | 2.5 to 3.5 MHz transducer 2nd to 4th ICS in left hemithorax (to 5th ICS on the right) at parasternal, midclavicular, AAL, PAL | NT pro-BNP | B-line co-related to NT pro-BNP (r = 0.69, P < 0.0001). High accuracy for B-line to predict aetiology of dyspnoea as of cardiac origin (AUC 0.893) |
Volpicelli [42] | Unselected acute emergency medicine admissions (n = 300) | 3.5 MHz convex transducer 8 areas in total Anterior - from the sternum to the AAL Lateral - from the AAL to PAL Each zone was divided into upper and lower halves | Chest X-ray | Diffuse B lines had sensitivity of 85.7% and a specificity of 97.7% for diagnosing radiologic interstitial oedema and a sensitivity of 85.3% and a specificity of 96.8% for diagnosing a clinical disease with diffuse interstitial oedema |
Volpicelli et al. [43] | Acute cardiac failure (n = 81) | 3.5 MHz convex transducer 11 areas - 3 anterior and 3 lateral on right side and 2 anterior and 3 lateral on left side | Chest X-ray NT pro-BNP | Significant resolution of B lines after treatment (P < 0.001). Significant co-relation between B-line and clinical score (r = 0.87; P < 0.001), and radiological score (r = 0.62; P < 0.001) and BNP levels (r = 0.44; P < 0.05) |
Prosen et al. [52] | Acutely dyspnoeic patients (n = 218) | 8 areas in total Anterior - from the sternum to the AAL Lateral - from the AAL to PAL Each zone was divided into upper and lower halves | NT pro-BNP Clinical score | B-line was the strongest predictor of acute heart failure with 100% sensitivity, 95% specificity, 96% PPV and 100% negative NPV to diagnose cardiac failure. B-line can reliably exclude pulmonary related dyspnoea in patients with elevated BNP and a history of cardiac failure |
Liteplo et al. [53] | Acutely dyspnoeic patients (n = 100) | 2-5 MHz transducer 8 areas in total Anterior - from the sternum to the AAL Lateral - from the AAL to PAL Each zone was divided into upper and lower halves | NT pro-BNP Clinical review | The presence of a completely positive test gave an infinite likelihood ratio for diagnosing congestive cardiac failure and a completely negative test gave a likelihood ratio of 0.22 (CI 0.06 to 0.8). |