• María José Cristo Ropero, Francisco Javier Rivera Rabanal, Tania Seoane García, Luis Madrona Jiménez, Álvaro Izquierdo Bajo, Rafael Hidalgo Urbano, Juan Carlos Garcia-Rubira, and Angel Vilches Arenas.
• Servicio de Cardiología, Hospital Virgen Macarena, Avenida Dr Fedriani sn, 41009, Seville, Spain.
• Intern Emerg Med. 2023 Jan 1; 18 (1): 249255249-255.

AbstractThe objectives of this study are to establish the usefulness of lung ultrasound with a handheld device to predict the risk of developing heart failure with the need for mechanical ventilation (MV) in acute coronary syndrome (ACS). This is a prospective study of consecutive patients admitted because of ACS-type myocardial infarction, without data of HF at admission in a tertiary hospital, between February 2017 and February 2018. Lung ultrasounds were performed with a handheld cardiologic device in the first 24 h, and defined as echo-positive (PE+) when exams revealed 3 or more B-lines in 2 or more bilateral quadrants. We related this finding to the need for MV during admission. We included 119 patients (65.1 ± 12.8 year; 75.6% male, 24.4% female; 87.4% in Killip class I, 12.6% in Killip class II). Pulmonary echography was positive (PE+) in 21 patients (17.6%). The sensitivity of PE+ to predict MV was 93.3%, the specificity 93.3%, and the area under the curve 0.93. In Cox regression analysis adjusted by CRUSADE score and Killip class, PE+ patients had a hazard ratio of 64.55 (CI 7.87; 529.25, p < 0.001) of needing MV. PE+ was associated with more frequent use of inotropes and mortality. Pulmonary ultrasonography with a handheld echocardiograph was predictive of severe heart failure and the need for mechanical ventilation in ACS with high specificity and sensitivity.© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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