Authors:
E Picano¹, R Sicari², L Gargani³, F Frassi⁴, M Agrusta⁵, P Tesorio⁶, G Mottola⁷, M Raciti⁸, ¹Mercogliano - Italy, ²Mercogliano - Italy, ³CNR - Pisa - Italy, ⁴CNR - Pisa - Italy, ⁵Mercogliano - Italy, ⁶CNR - Pisa - Italy, ⁷CNR - Pisa - Italy, ⁸Mercogliano - Italy,

Background: Ultrasound Lung Comets (ULCs) consist of multiple comet tails originating from water-thickened interlobular septa. They are a simple echographic sign correlated to extra-vascular lung water, whose increase is a possible harbinger of impending acute heart failure.
Aim: To assess the prognostic value of ULCs.
Methods: 205 in-hospital patients (68±13 years) admitted for dyspnea and/or chest pain syndrome were evaluated, upon admission, with a comprehensive 2D and Doppler echocardiographic examination and ULCs assessment. A patient ULC score was obtained by summing the number of comets from each of the scanning spaces in the anterior right and left hemithorax, from second to fifth intercostal space. All patients were followed-up for a median of 15 months.
Results: ULCs were present in 120 patients: 25 patients had mild (5 to 15), 37 moderate (16 to 30), and 58 severe (>30) ULCs. During the follow-up, 46 events occurred: 13 cardiac and 23 non-cardiac deaths, 1 non fatal myocardial infarction and 9 acute heart failure requiring hospitalization. Using a receiver-operating characteristics analysis, ULC>10 was the best predictor of future events (area under the curve=0.609). The 35-months event-free survival was highest in patients with no ULCs and lowest in patients with severe (>30) ULCs at entry (fig.). At multivariable analysis, ULCs provided additional prognostic information (Hazard Ratio=1.44, Confidence Interval=1.12-1.87, p<0.02) to clinical and echocardiographic variables.
Conclusion: ULCs provide useful information for prognostic stratification in patients admitted for dyspnoea and/or chest pain.