Trajectory, correlates, and outcomes of pulmonary congestion by lung ultrasound in patients hospitalized for acute pulmonary edema

Aims: Patients with acute pulmonary edema (APE) requiring an urgent heart failure (HF) hospitalization face poor prognosis largely due to pulmonary congestion. We aimed at assessing the patterns and variations of pulmonary congestion associated with different assessments of congestion and prognosis. Methods: This prospective study included patients with APE who underwent lung ultrasound (8-zone B-lines method) and echocardiography immediately after emergency department visit, with follow-up assessments on days 2, 3, 7, and discharge. B-type natriuretic peptide (BNP) levels were measured at admission, day 7, and discharge. The associations between B-line changes, other congestion marker changes and outcomes were assessed. Results: Among 137 patients (mean age: 77 ± 13 years; 61 % male), 71 % had New York Heart Association IV, 65 % had left ventricular ejection fraction <45 %, and median B-lines were 44 (32–58) on admission. While B-lines showed no association with other congestion markers at admission, they correlated significantly with pulmonary artery systolic pressure (PASP) from day 2 to discharge, and with E/e´ and BNP at day 7 and discharge. Throughout hospitalization, B-line changes consistently correlated with changes in other congestion markers (E/e´, PASP, and BNP) (all-p-values<0.05). Among congestion markers, B-lines showed the most prominent reduction from admission to day 2, and this reduction was associated with a lower risk of all-cause mortality or HF rehospitalization over a median 217-day follow-up (adjusted-HR, 95 %CI = 0.96, 0.94–0.99; p = 0.01). Conclusions: In APE, B-lines lacked association with other congestion markers immediately after hospitalization. However, B-lines decreased noticeably from admission to day 2, with changes correlating with other markers and prognosis.