Pulmonary congestion assessed by lung ultrasound in stable ambulatory patients with heart failure and preserved ejection fraction in primary care.
E, L.G., M, D., JM, M., M, I.C., L, C.F., C, C., G, D.F., R, G., H, E.J.K., & M, J. (2026). Pulmonary congestion assessed by lung ultrasound in stable ambulatory patients with heart failure and preserved ejection fraction in primary care.. Family practice. https://doi.org/10.1093/fampra/cmag050
E LG, M D, JM M, M IC, L CF, C C, et al. Pulmonary congestion assessed by lung ultrasound in stable ambulatory patients with heart failure and preserved ejection fraction in primary care.. Family practice. 2026; doi: 10.1093/fampra/cmag050
E LG, M D, JM M, et al. Pulmonary congestion assessed by lung ultrasound in stable ambulatory patients with heart failure and preserved ejection fraction in primary care.[J]. Family practice. 2026. DOI: 10.1093/fampra/cmag050.
@article{e2026,
author = {Leceaga-Gaztambide E and Domingo M and Manresa JM and Iniguez-Cruz M and Conangla-Ferrin L and Chacón C and Diez-Fadrique G and Garcia R and El Jaouhari Khlifi H and Juviña M},
title = {Pulmonary congestion assessed by lung ultrasound in stable ambulatory patients with heart failure and preserved ejection fraction in primary care.},
journal = {Family practice},
year = {2026},
doi = {10.1093/fampra/cmag050},
note = {PMID: 42485648},
}
TY - JOUR AU - Leceaga-Gaztambide E AU - Domingo M AU - Manresa JM AU - Iniguez-Cruz M AU - Conangla-Ferrin L AU - Chacón C AU - Diez-Fadrique G AU - Garcia R AU - El Jaouhari Khlifi H AU - Juviña M TI - Pulmonary congestion assessed by lung ultrasound in stable ambulatory patients with heart failure and preserved ejection fraction in primary care. T2 - Family practice PY - 2026 DO - 10.1093/fampra/cmag050 AN - PMID:42485648 ER -
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) accounts for a growing proportion of heart failure cases. Pulmonary congestion, particularly subclinical congestion, is often underestimated by symptoms and physical examination. Lung ultrasound enables detection of extravascular lung water through B-lines, even in early stages, but its role in HFpEF patients managed in primary care remains poorly defined. METHODS: This prospective, multisite observational study included ambulatory HFpEF patients with a prior hospitalization for heart failure decompensation and stable New York Heart Association class over the previous 3 months. Baseline evaluation included clinical assessment, biomarkers (N-terminal pro-brain natriuretic peptide, cancer antigen 125), frailty index, HF-related quality of life, 6-minute walking test, and bed-side lung ultrasound using a 28-zone protocol. Patients with pleural effusions were excluded, and B-lines were quantified offline. RESULTS: A total of 188 patients were analyzed (age 77.3 ± 9.9 years, 52.1% women, 46.9% obese, 81.9% New York Heart Association II, N-terminal pro-brain natriuretic peptide 974 pg/mL, 76% loop diuretic). Overall, 86.5% of patients showed at least one B-line, and one-third had ≥5 B-lines despite clinical stability. Higher B-line count was associated with higher systolic blood pressure, pulmonary crackles, and increased N-terminal pro-brain natriuretic peptide and cancer antigen 125 levels. In contrast, no significant relationship was found between B-lines and 6-minute walking test, frailty index, or HF-related quality of life. CONCLUSION: In stable ambulatory HFpEF patients managed in primary care, lung ultrasound frequently identifies subclinical pulmonary congestion. B-lines are associated with biomarkers of congestion, crackles, and systolic blood pressure, but not with functional capacity, frailty, or patient-reported health status.