ABC | Volume 110, Nº6, June 2018

Review Article Muniz et al Pulmonary ultrasound in patients with heart failure Arq Bras Cardiol. 2018; 110(6):577-584 Mid- axillary Anterior axillary Mid- clavicular Para- sternal Intercostal space Para- sternal Mid- clavicular Anterior axillary Mid- axillary Left side Right side 2 3 4 5 Figure 1 – Methodology for pulmonary ultrasound assessment: 28 fields (zones). Modified from Jambrik et al. 15 Figure 2 – Methodology for pulmonary ultrasound assessment: 8 fields (zones). Modified from Volpicelli et al. 12 PSL: para-sternal line; AAL: anterior axillary line; PAL: posterior axillary line. connectors: (heart failure) AND (pulmonary ultrasound) AND (thoracic ultrasound). The inclusion criteria adopted in the studies were: articles written in English, Portuguese or Spanish, approaching PU for the assessment of dyspnea or congestion in patients with HF. The data were extracted in a standardized way, by two independent researchers responsible for assessing the methodological quality of the manuscripts. Duplicate articles, reviews, editorials, letter to the editor, and studies conducted on animals and populations younger than 18 years were excluded. The search in the literature was performed in February 2017 and included articles from 2006 to 2016. The articles were selected in two steps. In the first, the abstracts were read and those not meeting the inclusion criteria were excluded. In the second step, the studies selected based on their abstracts were fully read, and those not meeting the inclusion criteria were excluded, according to the PRISMA model (Figure 3). Results Interobserver assessment in pulmonary ultrasound and comparison with other diagnostic methods Gustafsson et al. 19 have observed that nurses specialized in HF and trained in PU for 4 hours achieved a substantial level of interobserver analysis when compared to cardiologists (k =0.71 and 0.66) to assess B-lines and pleural effusion, respectively. 19 Those results and other data are shown in Table 1. Platz et al., 20 assessing the B-lines with Doppler echocardiographic data, have found a correlation with left ventricular (LV) end-diastolic diameter (EDD - p = 0.036) and LV end-systolic diameter (p = 0.026), with septal wall thickening (p = 0.009), LV mass index (p = 0.001), left atrial volume index (p = 0.005), tricuspid valve regurgitation velocity (p = 0.005) and systolic pulmonary artery pressure (SPAP, p = 0.003). 578