{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:07:47Z","timestamp":1791446867048,"version":"4.3.3"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":1694,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Lung ultrasound B-lines are the sonographic sign of pulmonary congestion and can be used in the differential diagnosis of dyspnoea to rule in or rule out acute heart failure (AHF). Our aim was to assess the prognostic value of B-lines, integrated with echocardiography, in patients admitted to a cardiology department, independently of the initial clinical presentation, thus in patients with and without AHF, and in AHF with reduced and preserved ejection fraction (HFrEF and HFpEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We enrolled consecutive patients admitted for various cardiac conditions. Patients were classified into three groups: (i) acute HFrEF; (ii) acute HFpEF; and (iii) non-AHF. All patients underwent an echocardiogram coupled with lung ultrasound at admission, according to standardized protocols. We followed up 1021 consecutive inpatients (69 \u00b1 12 years) for a median of 14.4 months (interquartile range 4.6\u201324.3) for death and rehospitalization for AHF. During the follow-up, 126 events occurred. Admission B-lines &amp;gt; 30, ejection fraction &amp;lt; 50%, tricuspid regurgitation velocity &amp;gt; 2.8 m\/s, and tricuspid annular plane systolic excursion &amp;lt; 17 mm were independent predictors at multivariable analysis. B-lines &amp;gt; 30 had a strong predictive value in HFpEF and non-AHF, but not in HFrEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ultrasound B-lines can detect subclinical pulmonary interstitial oedema in patients thought to be free of congestion and provide useful information not only for the diagnosis but also for the prognosis in different cardiac conditions. Their added prognostic value among standard echocardiographic parameters is more robust in patients with HFpEF compared with HFrEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.13206","type":"journal-article","created":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T05:35:35Z","timestamp":1619847335000},"page":"2660-2669","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Prognostic Value of Lung Ultrasound in Patients Hospitalized for Heart Disease Irrespective of Symptoms and Ejection Fraction"],"prefix":"10.1093","volume":"8","author":[{"given":"Luna","family":"Gargani","sequence":"first","affiliation":[{"name":"Institute of Clinical Physiology \u2013 C.N.R. , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5473-227X","authenticated-orcid":false,"given":"Nicola Riccardo","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Frassi","sequence":"additional","affiliation":[{"name":"Emergency Department, Azienda Ospedaliero-Universitaria Pisana , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Frumento","sequence":"additional","affiliation":[{"name":"Department of Political Sciences, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Poggianti","sequence":"additional","affiliation":[{"name":"Fondazione Toscana G. Monasterio , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Mazzola","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"De Biase","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Landi","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology \u2013 C.N.R. , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Masi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Taddei","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Indiana University , Indianapolis, IN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Sicari","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology \u2013 C.N.R. , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,1]]},"reference":[{"key":"2026012114210397400_ehf213206-bib-0001","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/eurjhf\/hfq045","article-title":"Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European society of cardiology and endorsed by the European society of intensive care medicine","volume":"12","author":"Gheorghiade","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2026012114210397400_ehf213206-bib-0002","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.hfc.2018.12.010","article-title":"Ultrasound of the lungs","volume":"15","author":"Gargani","year":"2019","journal-title":"Heart Fail Clin"},{"key":"2026012114210397400_ehf213206-bib-0003","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1378\/chest.127.5.1690","article-title":"\u2018Ultrasound comet-tail images\u2019: a marker of pulmonary edema\u2014a comparative study with wedge pressure and extravascular lung water","volume":"127","author":"Agricola","year":"2005","journal-title":"Chest"},{"key":"2026012114210397400_ehf213206-bib-0004","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.ejheart.2007.10.009","article-title":"Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides","volume":"10","author":"Gargani","year":"2008","journal-title":"Eur J Heart Fail"},{"key":"2026012114210397400_ehf213206-bib-0005","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/j.jcmg.2013.08.004","article-title":"Lung ultrasound for the evaluation of pulmonary congestion in outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography","volume":"6","author":"Miglioranza","year":"2013","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026012114210397400_ehf213206-bib-0006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/ejhf.1739","article-title":"Haemodynamic and metabolic phenotyping of hypertensive patients with and without heart failure by combining cardiopulmonary and echocardiographic stress test","volume":"22","author":"Pugliese","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2026012114210397400_ehf213206-bib-0007","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.euje.2006.09.004","article-title":"Clinical and echocardiographic determinants of ultrasound lung comets","volume":"8","author":"Frassi","year":"2007","journal-title":"Eur J Echocardiogr"},{"key":"2026012114210397400_ehf213206-bib-0008","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/1476-7120-4-34","article-title":"Evaluation of ultrasound lung comets by hand-held echocardiography","volume":"4","author":"Bedetti","year":"2006","journal-title":"Cardiovasc Ultrasound"},{"key":"2026012114210397400_ehf213206-bib-0009","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1002\/ejhf.289","article-title":"Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergenc","volume":"17","author":"Mebazaa","year":"2015","journal-title":"Eur J Heart Fail"},{"key":"2026012114210397400_ehf213206-bib-0010","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jchf.2017.09.023","article-title":"Integrative assessment of congestion in heart failure throughout the patient journey","volume":"6","author":"Girerd","year":"2018","journal-title":"JACC Hear Fail"},{"key":"2026012114210397400_ehf213206-bib-0011","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1002\/ejhf.1379","article-title":"Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial","volume":"21","author":"Pivetta","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026012114210397400_ehf213206-bib-0012","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1093\/eurheartj\/ehv745","article-title":"Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients","volume":"37","author":"Platz","year":"2016","journal-title":"Eur Heart J"},{"key":"2026012114210397400_ehf213206-bib-0013","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1002\/ejhf.1383","article-title":"Prevalence, pattern and clinical relevance of ultrasound indices of congestion in outpatients with heart failure","volume":"21","author":"Pellicori","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026012114210397400_ehf213206-bib-0014","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/j.amjcard.2019.02.008","article-title":"The added value of exercise stress echocardiography in patients with heart failure","volume":"123","author":"Fabiani","year":"2019","journal-title":"Am J Cardiol"},{"key":"2026012114210397400_ehf213206-bib-0015","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1002\/ehf2.12842","article-title":"Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure","volume":"7","author":"Rivas-Lasarte","year":"2020","journal-title":"ESC Hear Fail"},{"key":"2026012114210397400_ehf213206-bib-0016","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.cardfail.2007.07.003","article-title":"Prognostic value of extravascular lung water assessed with ultrasound lung comets by chest sonography in patients with dyspnea and\/or chest pain","volume":"13","author":"Frassi","year":"2007","journal-title":"J Card Fail"},{"key":"2026012114210397400_ehf213206-bib-0017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12947-015-0033-4","article-title":"Persistent pulmonary congestion before discharge predicts rehospitalisation in heart failure: a lung ultrasound study","volume":"13","author":"Gargani","year":"2015","journal-title":"Cardiovasc Ultrasound"},{"key":"2026012114210397400_ehf213206-bib-0018","doi-asserted-by":"crossref","DOI":"10.1038\/srep39426","article-title":"Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: a two-centre cohort study","volume":"6","author":"Coiro","year":"2016","journal-title":"Sci Rep"},{"key":"2026012114210397400_ehf213206-bib-0019","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1007\/s00392-018-1221-7","article-title":"Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF","volume":"107","author":"Palazzuoli","year":"2018","journal-title":"Clin Res Cardiol"},{"key":"2026012114210397400_ehf213206-bib-0020","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.jchf.2019.07.008","article-title":"Lung ultrasound in acute heart failure: prevalence of pulmonary congestion and short- and long-term outcomes","volume":"7","author":"Platz","year":"2019","journal-title":"JACC Hear Fail"},{"key":"2026012114210397400_ehf213206-bib-0021","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ijcard.2016.05.010","article-title":"Lung ultrasound and short-term prognosis in heart failure patients","volume":"218","author":"Cogliati","year":"2016","journal-title":"Int J Cardiol"},{"key":"2026012114210397400_ehf213206-bib-0022","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J"},{"key":"2026012114210397400_ehf213206-bib-0023","first-page":"577","volume-title":"Intensive Care Med","author":"Volpicelli","year":"2012"},{"key":"2026012114210397400_ehf213206-bib-0024","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1002\/ejhf.1499","article-title":"Expert consensus document: reporting checklist for quantification of pulmonary congestion by lung ultrasound in heart failure","volume":"21","author":"Platz","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026012114210397400_ehf213206-bib-0025","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/0163278703255230","article-title":"An overview of variance inflation factors for sample-size calculation","volume":"26","author":"Hsieh","year":"2003","journal-title":"Eval Health Prof"},{"key":"2026012114210397400_ehf213206-bib-0026","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1161\/CIRCULATIONAHA.108.783910","article-title":"Transition from chronic compensated to acute d compensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures","volume":"118","author":"Zile","year":"2008","journal-title":"Circulation"},{"key":"2026012114210397400_ehf213206-bib-0027","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1161\/CIRCULATIONAHA.104.492207","article-title":"Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalisation","volume":"112","author":"Yu","year":"2005","journal-title":"Circulation"},{"key":"2026012114210397400_ehf213206-bib-0028","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.jchf.2017.06.013","article-title":"Heart failure with mid-range (borderline) ejection fraction: clinical implications and future directions","volume":"5","author":"Hsu","year":"2017","journal-title":"JACC Hear Fail"},{"key":"2026012114210397400_ehf213206-bib-0029","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s10741-019-09868-0","article-title":"Congestion occurrence and evaluation in acute heart failure scenario: time to reconsider different pathways of volume overload","volume":"25","author":"Palazzuoli","year":"2019","journal-title":"Heart Fail Rev"},{"key":"2026012114210397400_ehf213206-bib-0030","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1093\/ehjci\/jez014","article-title":"Value of combined cardiopulmonary and echocardiography stress test to characterise the haemodynamic and metabolic responses of patients with heart failure and mid-range ejection fraction","volume":"20","author":"Pugliese","year":"2019","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026012114210397400_ehf213206-bib-0031","doi-asserted-by":"crossref","DOI":"10.1186\/1476-7120-9-6","article-title":"Lung ultrasound: a new tool for the cardiologist","volume":"9","author":"Gargani","year":"2011","journal-title":"Cardiovasc Ultrasound"},{"key":"2026012114210397400_ehf213206-bib-0032","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1093\/ndt\/gfw329","article-title":"Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a lust trial sub-project","volume":"31","author":"Gargani","year":"2016","journal-title":"Nephrol Dial Transplant"},{"key":"2026012114210397400_ehf213206-bib-0033","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1002\/ejhf.1604","article-title":"Lung ultrasound-guided treatment in ambulatory patients with heart failure: a randomized controlled clinical trial (LUS-HF study)","volume":"21","author":"Rivas-Lasarte","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026012114210397400_ehf213206-bib-0034","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.chest.2019.07.017","article-title":"Accuracy of several lung ultrasound methods for the diagnosis of acute heart failure in the ED","volume":"157","author":"Buessler","year":"2019","journal-title":"Chest"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ehf2.13206","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ehf2.13206","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/8\/4\/2660\/65569136\/eschf_8_4_2660.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/8\/4\/2660\/65569136\/eschf_8_4_2660.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T19:25:40Z","timestamp":1769023540000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/8\/4\/2660\/8344371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,5,1]]},"published-print":{"date-parts":[[2021,8,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.13206","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,8]]},"published":{"date-parts":[[2021,5,1]]},"assertion":[{"value":"2020-07-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}