Lung Comet tail artefact in diagnosis and monitoring of pulmonary congestion in patients with sistolic and diastolic Heart Failure

Purpose: Heart Failure (HF) is a growing public health problem. Pulmonary congestion is useful marker of decompensate congestive heart failure (CHF). The aim was to study the importance of Lung “Comet tail” artefact in diagnosis and monitoring of Pulmonary Congestion in patients with different types Heart Failure.

Material and methods: We studied 430 patients with II-IV NYHA class HF. 338 Patients have Systolic Heart Failure (SHF), 92 patient – HF with preserved systolic function (DHF), 70 patients with chronic obstructive pulmonary disease (COPD) and 155 patients with heart diseases, without HF (control). Lung sonography was done, from 10 points of thoracic wall which corresponded to the projection of lung lobes.

Results: In patients with CHF we significantly often found the “Comet tail Phenomenon” (CTPh) There was good correlation between the count of CTPh registration points from the thoracic wall and the heart failure NYHA class (r = 0.57), left ventricular systolic (r = 0.43) and diastolic (r = 0.34) diameters and negative correlation with EF% (r =-0.44). In the HF gr. CTPh was registered from 3 or more points of thoracic wall in 89.6%, in SHF -91.4%. in DHF -82.6%, in COPD -9.1% and in control -7.1% of patients. If we take 4 points and more as a reference value the sensitivity of sign in diagnosis of pulmonary congestion was 83.5% an specify – 97.6%. In CHF group CTPh was prominent, protracted and multiple while in the II group it was single and short lasting. After use of diuretics CTPh disappears or was less prominent then before treatment.

Conclusion: Thoracic US is accurate method for evaluationof pulmonary congestion in patients with systolic and diastolic HF. The US sign of pulmonary congestion in HF is a “Comet tail phenomenon”, which is multiple and registered from larger area of thoracic wall (4 points or more).