Two‐ Versus 8‐Zone Lung Ultrasound in Heart Failure: Analysis of a Large Data Set Using a Deep Learning Algorithm

• Published in: Journal of ultrasound in medicine Vol. 42; no. 10; pp. 2349 - 2356
• Main Authors: Baloescu, Cristiana, Chen, Alvin, Varasteh, Alexander, Toporek, Grzegorz, McNamara, Robert L., Raju, Balasundar, Moore, Chris
• Format: Journal Article
• Language: English
• Published: England 01.10.2023
• Subjects: heart failure; B-lines; machine learning; point-of-care ultrasound; lung ultrasound; artificial intelligence
• ISSN: 0278-4297; 1550-9613; 1550-9613
• DOI: 10.1002/jum.16262

Scanning protocols for lung ultrasound often include 8 or more lung zones, which may limit real-world clinical use. We sought to compare a 2-zone, anterior-superior thoracic ultrasound protocol for B-line artifact detection with an 8-zone approach in patients with known or suspected heart failure using a deep learning (DL) algorithm. Adult patients with suspected heart failure and B-lines on initial lung ultrasound were enrolled in a prospective observational study. Subjects received daily ultrasounds with a hand-held ultrasound system using an 8-zone protocol (right and left anterior/lateral and superior/inferior). A previously published deep learning algorithm that rates severity of B-lines on a 0-4 scale was adapted for use on hand-held ultrasound full video loops. Average severities for 8 and 2 zones were calculated utilizing DL ratings. Bland-Altman plot analyses were used to assess agreement and identify bias between 2- and 8-zone scores for both primary (all patients, 5728 videos, 205 subjects) and subgroup (confirmed diagnosis of heart failure or pulmonary edema, 4464 videos, 147 subjects) analyses. Bland-Altman plot analyses revealed excellent agreement for both primary and subgroup analyses. The absolute difference on the 4-point scale between 8- and 2-zone average scores was not significant for the primary dataset (0.03; 95% CI -0.01 to 0.07) or the subgroup (0.01; 95% CI -0.04 to 0.06). Utilization of a 2-zone, anterior-superior thoracic ultrasound protocol provided similar severity information to an 8-zone approach for a dataset of subjects with known or suspected heart failure.