Association of Lung Ultrasound B-lines with Left Ventricular Diastolic Function in Clinically Euvolemic Hemodialysis Patients

Introduction: Left ventricular diastolic dysfunction (LVDD) frequently occurs in haemodialysis patients and is associated with adverse outcomes. Lung ultrasound (LUS) has been recently proposed for the quantification of extravascular lung water (ELW) through assessment of B-lines. LUS findings and their relationship with LVDD in clinically euvolemic haemodialysis patients were investigated in this study. Methods: Echocardiography and LUS examinations were performed on each patient. Multivariate linear regression and forwards stepwise logistic regression were performed to determine the relationship between B-lines and LVDD. A receiver-operator characteristic curve (ROC) with area under the curve (AUC) was calculated to determine the accuracy of B-lines for evaluating LVDD.Results: A total of 119 patients were enrolled. The number of B-lines was statistically related to echocardiographic parameters (LAVI, LVEDVI, E/A and E/e') of diastolic function, while the relationship between B-lines and LVEF disappeared after adjusting for potential confounding factors. Additionally, compared with the mild B-line group (B-lines: <14), the moderate (B-lines: 14-30) and severe B-line groups (B-lines: >30) were associated with an increased risk of LVDD (OR 24.344, 95% CI 4.854-122.084, P < 0.001 and OR 94.552, 95% CI 9.617-929.022, P < 0.001, respectively). Furthermore, the AUC of the ROC curve for B-lines predicting LVDD was 0.845, and the cut-off of B-lines was 14.5 (sensitivity 64.91%, specificity 93.55%).Conclusion: LUS B-lines were closely associated with left ventricular diastolic function in clinically euvolemic haemodialysis patients. Moreover, our findings suggested a B-line >= 14.5 as a reliable cut-off value for identifying patients with LVDD. LUS B-lines may be used as a novel indicator for evaluating LVDD.