Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Assistant professor Luna Gargani, University of Pisa, Italy
- Second opponent: Head of Advanced Heart Failure Unit, Jesus Alvarez-Garcia, Hospital Ramón y Cajal, Spain
- Third member and chair of the evaluation committee: Professor II Kjetil Sunde, University of Oslo
Chair of the Defence
Associate Professor Lena Kristine Bugge Nordberg, University of Oslo
Principal Supervisor
Peder Langeland Myhre, University of Oslo
Summary
Major causes of hospitalization for acute dyspnea include acute heart failure (AHF), acute exacerbations of COPD (AECOPD), and pulmonary infections. Accurate diagnosis of the underlying etiology is essential for timely management.
Lung ultrasound is a rapid, non-invasive tool that provides important information about pulmonary congestion by evaluating reverberation imaging artifacts, A-lines, and B-lines. A-lines are horizontal reverberation artifacts indicating air-rich lungs, whereas B-lines are vertical artifacts indicating increased pulmonary tissue density.
This thesis aimed to evaluate the feasibility and the diagnostic and prognostic performance of lung ultrasound, focusing on A-lines and B-lines in patients with acute dyspnea and their relationship with markers of cardiac dysfunction and congestion.
In three prospective studies, patients with AHF, AECOPD, and COVID-19 were evaluated using a standardized 8-zone lung ultrasound protocol. The sum of artifact counts across the eight lung zones served as the basis for correlations with clinical findings, echocardiography, and laboratory markers. Long-term outcomes were mortality and rehospitalization at 30 days, 90 days, and 12 months. A contextual narrative literature review was also conducted.
B-lines were common across all cohorts and correlated with disease severity. In AHF, B-line counts declined from admission to discharge and were prognostically significant. A-lines provided no clinical value and were associated with chest wall characteristics. In AECOPD, patients with known heart failure had more B-lines, but B-lines alone were not diagnostic of concurrent AHF. In COVID-19, B-lines were strongly associated with respiratory distress and inflammatory markers but not with increased mortality or cardiac biomarkers.
Overall, the findings support prior evidence on the value of B-lines in assessing congestion in AHF. However, caution is warranted when interpreting LUS findings as indicating intercurrent cardiac disease in patients with pulmonary disease or infections.
Additional information
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