A review of role of lung ultrasound and clinical congestion score in acute left ventricular failure

Praveen M. P., Lokesh Shanmugam, P. Arun Prasath


Congestive cardiac failure (CCF) is a worldwide phenomenon and affects millions of people years and is accompanied with high mortality. The present review is undertaken to evaluate the usefulness of Lung Ultrasound Scan in diagnosis and to identify its role as a marker of clinical outcome in patients with Acute LVF. A review of literature was done to find the role of lung ultrasound and clinical congestion score in acute left ventricular failure from search engines such as PubMed, google scholar. Major exclusion criteria were the studies that included patients with Right Ventricular Failure, renal insufficiency, other respiratory causes of breathlessness like pneumonia, pulmonary embolism, pneumothorax and pleural effusion. This review concluded that lung ultrasonography is as a rapid, non-invasive, bedside tool for the diagnosis and risk assessment of pulmonary congestion in Acute LVF.


Acute heart failure, Clinical Congestion score, Hospital stay, Kerly B lines, Lung ultrasound

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Ansari N, Hasan A, Owais M. A study of inflammatory markers and their correlation with severity in patients with chronic heart failure, Biomedical Research: 2012;23(3):408-15.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics- 2016 Update: A report from the American Heart Association. Circulation. 2016;133:e38-e360.

Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Cardiac Failure Review. 2017;3(1):7-11.

Stewart S, Wilkinson D, Hansen C, Vaghela V, Mvungi R, McMurray J, et al. Predominance of heart failure in the Heart of Soweto Study cohort: emerging challenges for urban African communities. Circulation. 2008 Dec 2;118(23):2360-7.

Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D, et al. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries. Arch Intern Med. 2012 Oct 8;172(18):1386-94.

Caruana L, Petrie MC, Davie AP, McMurray JJ. Do patients with suspected heart failure and preserved left ventricular systolic function suffer from diastolic heart failure or from misdiagnosis? A prospective descriptive study. BMJ. 2000;321(7255):215-8.

Nadar S, Prasad N, Taylor RS, Lip GY. Positive pressure ventilation in the management of acute and chronic cardiac failure: a systematic review and meta-analysis. Int J Cardiol. 2005;99(2):171-85.

Mant J, Doust J, Roalfe A, Barton P, Cowie MR, Glasziou P, et al, Systematic review and individual patient data meta-analysis of diagnosis of heart failure, with modelling of implications of diagnostic strategies in primary care. Health Technol Assess. 2009:13(32);1-248.

Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Inten Care Med. 2012 Apr 1;38(4):577-91.

Cook DJ, Simel DL. Does this patient have abnormal central venous pressure?. JAMA. 1996 Feb 28;275(8):630-4.

Aras MA, Teerlink JR. Lung ultrasound: a ‘B-line’to the prediction of decompensated heart failure. Europ Heart J. 2016;(37):1252-4.

Anderson KLI, Jenq KY, Panebianco NL, Dean AJ. Diagnosing heart failure failure among acutely dyspneic patients with cardiac, inferiorvenacava and lung ultrasonography. Am J Emerg Med. 2013;31(8):1208-14.

Bianucci R, Loynes RD, Sutherland ML, Lallo R, Kay GL, Froesch P, et al. Forensic analysis reveals acute decompensation of chronic heart failure in a 3500-year-old Egyptian dignitary. J Forensic Sci. 2016;61:1378-81.

Chamsi-Pasha MA, Chamsi-Pasha H. Avicenna's contribution to cardiology. Avicenna J Med. 2014 Jan;4(1):9-12.

Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, et al. Effect of Vasodilator Therapy on Mortality in Chronic Congestive Heart Failure. N Engl J Med. 1986;314:1547-52.

Paul L, inventor; Mauro, Lewis, assignee. Piezoelectric signaling apparatus. United States patent US 2,248,870. 1941 Jul 8.

Joyner CR Jr, Herman RJ, Reid JM. Reflected ultrasound in the detection and localization of pleural effusion. JAMA. 1967;200:399-402.

La Grange P, Foster PA, Pretorius LK. Application of the Doppler ultrasound bloodflow detector in supraclavicular brachial plexus block. Br J Anaesth 1978;50:965-7.

Lichtenstein D. Lung ultrasound in the critically ill. In: Yearbook of Intensive Care and Emergency Medicine. Heidelberg: Springer; 2004:625-644.

American Heart Association. Heart Disease and Stroke Statistics–2005 Update. Dallas, TX: American Heart Association; 2005.

O’Connell JB, Bristow MR. Economic impact of heart failure in the United States: time for a different approach. J Heart Lung Transplant. 1994;13 Suppl:S107-12.

Koelling TM, Chen RS, Lubwama RN, Gilbert JL, Eagle KA. The expanding national burden of heart failure in the United States: the influence of heart failure in women. Am Heart J. 2004;147(1):74-8.

Huffman MD, Prabhakaran D. Heart failure: Epidemiology and prevention in India. Nat Med J India. 2010;23(5):283-8.

Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D’Agostino RB, Kannel WB, et al. Lifetime risk for developing congestive heart failure: The Framingham Heart Study. Circulation. 2002;106:3068-72.

Mann DL, Bristow MR. Mechanisms and models in heart failure: the biomechanical model and beyond. Circulation. 2005 May 31;111(21):2837-49.

Cowie MR, Mosterd A, Wood DA, Deckers JW, Poole-Wilson PA, Sutton G, et al. The epidemiology of heart failure. Europ Heart J. 1997 Feb 1;18(2):208-25.

Yancy CW, Abraham WT, Albert NM, Clare R, Stough WG, Gheorghiade M, et al. Quality of care of and outcomes for African Americans hospitalized with heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry. J Am Coll Cardiol. 2008 Apr 29;51(17):1675-84.

Exner DV, Dries DL, Domanski MJ, Cohn JN. Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med. 2001 May 3;344(18):1351-7.

McMurray JJ, Stewart S. Epidemiology, aetiology, and prognosis of heart failure. Heart. 2000;83(5):596-602.

Mayosi BM. Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa. Heart. 2007;93(10):1176-83.

Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342(15):1077-84.

Zühlke LJ, Engel ME, Watkins D, Mayosi BM. Incidence, prevalence and outcome of rheumatic heart disease in South Africa: A systematic review of contemporary studies. Int J Cardiol. Elsevier Ireland Ltd; 2015 Jul 2;199:375-383.

Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. 2005;112(23):3608-16.

McMurray JJ, Pfeffer MA. Heart failure. Lancet 2005;365(9474):1877-89.

Kitzman DW. Exercise intolerance. Prog Cardiovasc Dis. 2005;47(6):367-79.

Brausnwald E. Disorders of the heart: normal and abnormal myocardial function. In: Fauci AS, editor. Harrison’s principles of internal medicine, 14thed. New York: McGraw-Hill; 1998:1278-1286.

Gehlbach BK, Geppert E. The pulmonary manifestations of left heart failure. Chest. 2004;125(2):669-82.

West JB, Dollery CT, Naimark A. Distribution of blood flow in isolated lung: relation to vascular and alveolar pressures. J Appl Physiol. 1964;19:713-24.

Malik AB, Vogel SM, Minshall RD, Tiruppathi C. Pulmonary circulation and regulation of fluid balance. Textbook of respiratory medicine. 3rd Edn. Philadelphia: WB Saunders Company; 2000:119-154.

Tsukimoto K, Mathieu-Costello O, Prediletto R, Elliott AR, West JB. Ultrastructural appearances of pulmonary capillaries at high transmural pressures. J Appl Physiol: 1991;71(2):573-82.

Dassanayaka S, Jones SP. Recent developments in heart failure. Circula res. 2015;117(7):e58-63.

Gargani L. Lung ultrasound: a new tool for the cardiologist. Cardiovasc Ultrasound. 2011;9:6.

Shyamsundar M, Attwood B, Keating L, Walden AP. Clinical review: the role of ultrasound in estimating extra-vascular lung water. Crit Care. 2013 Oct;17(5):237.

Lichten stein D, Meziere G, Biderman P, Gepner A, Barre O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156:1640-6.

Lodato JA, Ward RP, Lang RM. Echocardiographic predictors of pulmonary embolism in patients referred for helical CT. Echocardio. 2008;25:584-90.

Diacon AH, Brutsche MH, Soler M. Accuracy of pleural puncture sites. A prospective comparison of clinical examination with ultrasound. Chest. 2003;123:436-41.

Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a 2 year experience with 250 patients. Am J Cardiol. 1967;20(4):457-64.

Rhode LE, da-silva Beck L, Goldraich L, Grazziotin TC, Palombini DV, Polanczyk CA, et al. Reliabiliy and prognostic value of traditional signs and symptoms in outpatients with congestive heart failure. Can J Cardiol. 2004;20(7):697-702.

Tamargo J, Lopez-Sendon J. Novel therapeutic targets for the treatment of heart failure. Nature reviews Drug Discovery. 2011 Jul;10(7):536-55.

Miglioranza MH, Gargani L, Sant'Anna RT, Rover MM, Martins VM, Mantovani A, et al. Lung ultrasound for the evaluation of pulmonary congestion in outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography. JACC: Cardiovascular Imaging. 2013 Nov 1;6(11):1141-51.

Jambrik Z, Monti S, Coppola V, Agricola E, Mottola G, Miniati M, et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am j Cardiol. 2004 May 15;93(10):1265-70.