Assessing congestion in acute heart failure using cardiac and lung ultrasound - a review

ABSTRACT

Introduction: Acute heart failure (AHF) is one of the leading causes of hospital admissions and is characterized by systemic and pulmonary congestion, which often precedes the overt clinical signs and symptoms. Echocardiography in the management of chronic HF is well described; however, there are less evidence regarding echocardiography and lung ultrasound (LUS) in the acute setting.

Areas covered: We have summarized current evidence regarding the use of echocardiography and LUS for assessing congestion in patients with AHF. We discuss the value and reliability of handheld/pocketsize ultrasound devices in AHF.

Expert opinion: Echocardiography is an essential tool for the diagnostic work up in patients with AHF. No individual parameter reliably detects congestion, thus the physician must integrate several measurements from the right and left heart. Novel methods and advances in cardiac imaging and clinical chemistry make it possible to detect congestion at an early stage. LUS is particularly helpful in assessing congestion, and it has demonstrated diagnostic, therapeutic, and prognostic value in AHF. LUS is relatively easy to learn and allows for quick assessment of the presence of pulmonary congestion and pleural effusion. We recommend integration of LUS for routine management of patients with AHF.

KEYWORDS:

• Acute heart failure
• B-lines
• chest radiography
• congestion
• echocardiography
• lung ultrasound
• natriuretic peptides

Article highlights

• Ultrasound in the management of chronic heart failure (HF) is well described, while there are less evidence regarding echocardiography and lung ultrasound in the acute setting.

• There is no individual parameter that reliably detects congestion, thus the physician must integrate several measurements from the right and left heart.

• Novel methods and advances in cardiac imaging and clinical chemistry make it possible to detect congestion at an early stage.

• Lung ultrasound is a helpful tool in assessing congestion, and it has demonstrated diagnostic, therapeutic, and prognostic value in acute HF.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Declaration of interest

Dr. Johannessen has received grants from the Norwegian Lung Association, Astra-Zeneca via the Norwegian Lung association, and the Norwegian Association for Ultrasonography. Dr. Myhre has served on advisory boards for Novartis and Novo Nordisk, and has received consulting honoraria from Novartis, AmGen and Novo Nordisk. Dr. Omland has served on advisory boards for Abbott Diagnostics, Roche Diagnostics and Bayer and has received research support from Abbott Diagnostics, Novartis, Roche Diagnostics, Singulex and SomaLogic via Akershus University Hospital, and speaker’s or consulting honoraria from Roche Diagnostics, Siemens Healthineers and CardiNor.

Additional information

Funding

Dr. Johannessen is supported by a grant from the University of Oslo and Dr. Myhre is supported by a grant from the South-Eastern Norway Regional Health Authority.