ArticleHeart and vessels2026
Early lung ultrasound for clinical risk stratification in acute coronary syndrome: a prospective cohort study.
Article in Heart and vessels, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Early identification of pulmonary congestion in acute coronary syndrome (ACS) remains challenging and is associated with adverse outcomes. Lung ultrasound (LUS) is a rapid bedside tool that may improve early clinical risk stratification. We conducted a prospective observational cohort study including 189 patients with type-1 ACS. LUS was performed within 24 h of admission; LUS positivity was defined as ≥ 3 B-lines in ≥ 2 zones per hemithorax. The number of lung segments with ≥ 3 B-lines was analyzed as a continuous variable. NT-proBNP and CA125 were also measured within 24 h of admission. The primary in-hospital outcome was acute heart failure (AHF), defined as the need for intravenous diuretics or mechanical ventilatory support. The long-term outcome was a 1-year composite of all-cause death, stroke, reinfarction, or hospitalization for heart failure. LUS positivity was present in 15.9% of patients. AHF occurred in 90% of LUS-positive patients compared with 20.8% of LUS-negative patients (p < 0.001). After multivariable adjustment, LUS positivity remained strongly associated with AHF. Each additional LUS-positive lung segment independently increased the odds of AHF (OR 1.59 per segment, 95% CI 1.29–1.97, p < 0.001). Receiver operating characteristic analysis showed good discrimination for NT-proBNP (AUC 0.84) and LUS-positive segments (AUC 0.78) in identifying AHF, while CA125 showed moderate discrimination (AUC 0.71). During 1-year follow-up, 27 patients experienced the composite endpoint. LUS positivity independently predicted the outcome (adjusted HR 8.2, 95% CI 3.1–21.6, p < 0.001), and each additional LUS-positive segment increased event risk (adjusted HR 1.4 per segment, 95% CI 1.2–1.7, p < 0.001). LUS findings provided incremental prognostic value beyond clinical variables and NT-proBNP. Early lung ultrasound provides robust and independent prognostic information in ACS for both early heart failure deterioration and 1-year outcomes. LUS, together with NT-proBNP and CA125, may improve early clinical risk stratification using a simple bedside approach.
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