Cardiopulmonary Combined With Ultrasonography For The Observation Of Pulmonary Comet Tail In Patients With Heart Failure And Pulmonary Hypertension

Objective:To investigate the B line performance of heart and lung combined ultrasound in patients with heart failure and pulmonary hypertension and analyze its clinical significance.Methods:In the CCU and ICU,75 patients with left heart failure with grade III and IV heart failure were selected.According to the pulmonary artery pressure,the patients were divided into normal pulmonary artery pressure groups(n=33),mild pulmonary hypertension group(n=25),moderate-severe pulmonary hypertension group(n=17);Each patient was followed by eight sonographers who had no knowledge of the patient's condition to perform an eight-zone lung scan to count their B-line counts and measure plasma BNP levels.All patients underwent echocardiography to measure left ventricular diameter(LVD),right ventricular diameter(RVD),and left ventricular ejection fraction(LVEF).The LVD,RVD,and LVEF of three groups of patients with different pulmonary artery pressures were compared by one-way ANOVA,and the LSD-t test was used for comparison between the two groups.The Kruskal-wallis H test was used to compare plasma BNP concentrations and B-line numbers in three groups of patients with different pulmonary artery pressures.Mann-Whitney U test was used for the comparison between the two groups.The Mann-Whitney U test was used to compare plasma BNP concentrations and B-line numbers between patients with grade III heart failure and those with grade IV heart failure.The ROC curve method was used to evaluate the diagnostic value of plasma BNP levels and B-line counts,and the optimal threshold for the diagnosis of pulmonary hypertension in patients with severe heart failure with plasma BNP levels and B-line numbers was obtained.Results:Comparing the values between groups,there was no significant difference in gender and age between the three groups of patients with different pulmonary artery pressure(P>0.05).There were significant differences in plasma BNP levels,B-line numbers,and normal pulmonary artery pressure in patients with mild pulmonary hypertension(BNP:U=210.500,B-line:U=189.000,P<0.05).There were significant differences in BNP and B line counts between patients with moderate to severe pulmonary hypertension and normal pulmonary artery pressure(BNP level:U=47.000,B-line number:U=38.5000,P<0.001).The difference between BNP and B lines and mild pulmonary hypertension in patients with moderate to severe pulmonary hypertension was statistically significant(BNP level:U=73.000,B line number:U=64.000,P<0.001).There were significant differences in plasma BNP levels and B-line numbers between patients with grade III heart failure and those with grade IV heart failure(BNP levels:U=444.000,B-line numbers:U=463.500,P<0.05).The difference in RVD between patients with mild pulmonary hypertension and those with normal pulmonary arterial pressure was statistically significant(t=0.553,P< 0.001).The difference in RVD between patients with Medium and heavy pulmonary hypertension and those with normal pulmonary arterial pressure was statistically significant(t=0.553,P<0.001).The difference in RVD between patients with Medium and heavy pulmonary hypertension and those with mild pulmonary arterial pressure was statistically significant(t=0.553,P<0.001).However,there was no significant difference in LVD and LVEF between the three groups(P>0.05).Plasma BNP levels in patients with severe left heart failure with normal pulmonary arterial pressure,mild pulmonary hypertension,and moderate to severe pulmonary hypertension were 890(614,1516),1460(1245,1950),2660(1670,3279)pg/ml,The number of B lines were 12(9,16),17(14,18)and 26(20,28),respectively.The RVDs were(22.1±1.7),(24.9±2.0),(26.3±2.8)mm,respectively.Levels of plasma BNP in patients with grade III heart failure and grade IV heart failure were 1172(705,1835),1590(1250,2250)pg/ml,and B lines were 14(10,19)and 17(14,22).The optimal threshold for the diagnosis of pulmonary hypertension in patients with severe heart failure by B line number was 14.The sensitivity and specificity were 88.1% and 66.7%,respectively.The area under the ROC curve was 0.836,and the 95% confidence interval was 0.746 to 0.925.The optimal threshold for the diagnosis of pulmonary hypertension in patients with severe heart failure using plasma BNP levels was 1225pg/ml,with sensitivity and specificity of 85.7% and 69.7%,respectively.The area under the ROC curve was 0.814,and the 95% confidence interval was 0.717 to 0.911.Conclusion:In severe heart failure patients,the performance of the B-line in the lung under different pulmonary artery pressures is correlated,and the B-line number increases with the increase of the severity of pulmonary hypertension.It is worth further study and application.