Lung Ultrasound for the Assessment of Lung Congestion in Advanced Heart Failure Patients Treated with Intermittent Inotropes

Introduction: Lung ultrasound (LUS) for the assessment of pulmonary congestion in heart failure (HF) patients is increasingly utilized. Intravenous (IV) Inotropes have shown to improve hemodynamics in acute HF patients, mainly evaluated by right heart catheterization and echocardiography. However, despite symptomatic improvement, its use in chronic HF patients is still debatable. We aimed to evaluate the effect of intermittent IV Inotropes therapy on pulmonary congestion in advanced HF patients by using LUS.

Methods: Patients diagnosed with advanced HF and treated with intermittent IV Inotropes at the Tel Aviv Sourasky Heart Failure day-care unit were included. Bilateral LUS was performed for the assessment of B lines, suggesting of pulmonary congestion. LUS score based on the number of B lines (higher = worse) was assigned to each patient and compared pre- and post-treatment.

Results: Between October and November 2020, nine patients were intermittently treated with IV Inotropes (six with Milrinone and three with Levosimendan). The mean age was 73(±7) years and all were men. The mean left ventricular ejection fraction was 31(±7) % with New York Heart Association Class 3(±1). The mean pre-treatment LUS score was higher on the right lung compared to the left (19±6 vs. 15±6). The mean post-treatment right LUS score was 14(±5) and left LUS was 14(±7). Compared to levosimendan, Milrinone treatment produced a higher reduction in right LUS score (-7 (32%) vs -2 (15%)). Among six patients treated solely with IV Furosemide, we observed a mean reduction of -5 points (27%) in right LUS.

Conclusion: Using LUS, we observed a prominent reduction in pulmonary congestion after the use of IV inotropes, supporting their symptomatic benefit. Milrinone produced a larger reduction in LUS score compared with either Levosimendan or IV Furosemide.