Prognostic value of exercise-induced pulmonary congestion by lung ultrasound in patients with heart failure.

B-lines significantly increased from rest to peak exercise workload in patients with heart failure.

• The total number of B-lines was 1.9 ± 2.1 at rest.
• B-lines significantly increased to 5.4 ± 3.5 at peak workload.
• Peak workload averaged 40 W during symptom-limited exercise echocardiography using a bicycle ergometer.
• B-lines were evaluated using a 2-site simplified scan.

A cut-off value of exercise-induced B-lines ≥7 at peak workload was identified as related to cardiac events by receiver operating characteristic curve analysis.

• The cut-off value was B-lines ≥7 at peak workload.
• Sensitivity for predicting cardiac events was 50%.
• Specificity for predicting cardiac events was 79%.
• The analysis was performed in 124 patients with HF (71 [57–78] years, 65% male).

Patients with B-lines ≥7 at peak workload had significantly worse event-free survival than those with B-lines <7 at peak workload.

• Kaplan-Meier analysis showed significantly worse event-free survival in the B-lines ≥7 group.
• Log-rank test P = .002.
• During a follow-up period of 25 months, 26 patients had cardiac events.
• The cardiac event endpoint was defined as cardiac death or hospitalization for HF.

B-lines ≥7 at peak workload were independently related to cardiac events.

• Independent association was established after multivariable analysis.
• The study enrolled patients admitted to Okayama University Hospital between February 2021 and June 2024.
• Total sample size was 124 patients with HF.
• Exercise echocardiography was performed at the time of discharge.

Pulmonary congestion during exercise, quantified by B-lines on lung ultrasound, is related to poor prognosis in patients with heart failure.

• B-lines assessed by lung ultrasound quantitatively identify pulmonary congestion.
• The 2-site simplified scan was used to evaluate B-lines at rest and at peak workload.
• The study design was a single-center cohort study at Okayama University Hospital.
• The median patient age was 71 [57–78] years and 65% were male.