Lung Ultrasound to Assess Pulmonary Congestion in Patients with Acute Exacerbation of COPD

Abstract

Purpose: Heart failure (HF) often coexists with chronic obstructive pulmonary disease (COPD) and is associated with worse outcomes. We aimed to assess the feasibility of detecting vertical artifacts (B-lines) on lung ultrasound (LUS) to identify concurrent HF in patients hospitalized with acute exacerbation of COPD (AECOPD). Second, we wanted to assess the association between B-lines and the risk of rehospitalization for AECOPD or death. Patients and Methods: In a prospective cohort study, 123 patients with AECOPD underwent 8-zone bedside LUS within 24h after admission. A positive LUS was defined by ≥3 B-lines in ≥2 zones bilaterally. The ability to detect concurrent HF (adjudicated by a cardiologist committee) and association with events were evaluated by logistic-and Cox regression models. Results: Forty-eight of 123 patients with AECOPD (age 75±9 years, 57[46%] men) had concurrent HF. Sixteen (13%) patients had positive LUS, and the prevalence of positive LUS was similar between patients with and without concurrent HF (8[17%] vs 8[11%], respectively, p=0.34). The number of B-lines was higher in concurrent HF: median 10(IQR 6–16) vs 7(IQR 5–12), p=0.03. The sensitivity and specificity for a positive LUS to detect concurrent HF were 17% and 89%, respectively. Positive LUS was not associated with rehospitalization and mortality: Adjusted HR: 0.93(0.49–1.75), p=0.81. Conclusion: LUS did not detect concurrent HF or predict risk in patients with AECOPD.