While ultrasound lung comets (ULC) at rest provide prognosis information inpatients presenting with heart failure with reduced ejection fraction (HF-rEF), cardiopulmonary exercise testing (CPET) remains reference. This study aims to compare dynamic ULC with CPET measurements and stress echocardiography on HF-rEF patients.

Forty patients with HF-rEF (left ventricle ejection fraction below 40%) and 10 control patients matched on age and gender were included. Evaluation was performed by CPET (with oxygen uptake, VO₂; carbon dioxide output, VCO₂; ventilation, VE), stress echocardiography (with E and Ea wave velocities) and pulmonary echography (with baseline and postexercise ULC). ULC were assessed using a semi-quantitative method (LUS score). Cox regression analysis and areas under receiver-operator-curve (AUROC) analysis were performed on HF-rEF patients with all-cause mortality as main endpoint.

One-year mortality was 12.5% among HF-rEF patients. Baseline and postexercise ULC were associated with mortality (respective adjusted hazard-ratio HR=1.25 (CI 95=1.05–1.49, P=0.01) and HR=1.38 (CI 95=1.11–1.71, P=0.003), independently from peak VO₂). Postexercise ULC tended to be more discriminative than baseline ULC, with respective AUROC=0.89 (P=0.006) and AUROC=0.79 (P=0.038). Discrimination of VE/VCO2 slope was similar (AUROC=0.92, P=0.003), peak E/Ea ratio's tended to be lower (AUROC=0.78, P=0.045) and peak VO₂ was not discriminative of mortality. Postexercise ULC were correlated with peak VO₂ (r=−0.31, P=0.03), VE/VCO₂ slope (r=0.58, P<0.001) and E/Ea ratio (r=0.40, P=0.01). ULC did not vary in healthy patients between baseline and effort (Table 1, Fig. 1).

Dynamic assessment of ULC improves risk stratification of ambulatory HF-rEF patients in addition to CPET measurements such as peak VO₂.