# Lung ultrasound guided management in chronic heart failure: an updated systematic review and meta-analysis of randomized controlled trials

## TL;DR

A review of recent studies finds that lung ultrasound-guided management reduces urgent heart failure visits but not hospitalizations, with no impact on mortality or kidney function.

## Contribution

An updated synthesis of randomized trials shows LUS-guided care reduces urgent heart failure visits compared to standard care.

## Key findings

- LUS-guided management significantly reduced heart failure urgent visits by 69%.
- No significant difference was found in heart failure hospitalization rates.
- Mortality, hypokalaemia, and worsening renal function were unaffected by LUS-guided management.

## Abstract

Existing systematic reviews support the prognostic and therapeutic value of lung ultrasound (LUS) in heart failure (HF), but recent randomized controlled trials (RCTs) in chronic HF justify an up-to-date synthesis.

A systematic search of OVID via Medline, SCOPUS, COCHRANE, and CINAHL was conducted from inception until 25 February 2025. The study was registered with PROSPERO (ID: CRD420251003434). RCTs of LUS interventions in patients with chronic HF were included. The primary outcomes were HF urgent visits and HF hospitalizations. Secondary outcomes included mortality, hypokalaemia, and worsening renal function. Five RCTs, involving a total of 694 patients, were included in meta-analyses, with variability in LUS-based definitions of pulmonary congestion across studies. LUS-guided management was associated with a significant reduction in HF urgent visits [RR 0.31 (95% CI 0.17, 0.55), I2 = 0%] and a nonsignificant improvement in HF hospitalizations [RR 0.76 (95% CI 0.48, 1.18), I2 = 38.9%]. There was no difference in the rates of mortality, hypokalaemia, or worsening renal function.

LUS-guided management is associated with a significant reduction in urgent HF visits and a nonsignificant reduction in HF hospitalizations, with no difference in rates of mortality, hypokalaemia, or worsening renal function. Future studies should aim to establish an optimal, standardized LUS-based definition of pulmonary congestion in chronic HF.

Graphical AbstractLung ultrasound (LUS) in chronic heart failure (HF). This systematic review and meta-analysis assessed randomized controlled trials (RCTs) of LUS vs. standard care in the treatment of chronic HF. NS: nonsignificant; RR: risk ratio, 95% confidence intervals displayed.For image description, please refer to the figure legend and surrounding text.

Lung ultrasound (LUS) in chronic heart failure (HF). This systematic review and meta-analysis assessed randomized controlled trials (RCTs) of LUS vs. standard care in the treatment of chronic HF. NS: nonsignificant; RR: risk ratio, 95% confidence intervals displayed.