Introduction: Lung ultrasound and left atrial strain are promising methods for assessing pulmonary conges-tion and left atrial dysfunction in patients with heart failure with preserved ejection fraction (HFpEF).

Methods: To evaluate the correlation of lung ultra-sound with left atrial strain, we enrolled thirty-six pa-tients (24 women, 12 men, mean age 70 ± 6 years) with clinical signs of heart failure. The exclusion criteria were: left ventricular ejection fraction <55%, signifi-cant valvular or pulmonary disease, severe pulmonary arterial hypertension. The patients underwent a com-plex echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-PALS), lung ultrasound assessment of B-lines on the antero-lateral and posterior chest wall, and measurement of NT-proBNP levels.

Results: The mean ejection fraction was 65.5 ± 8.6%. In 28 patients (85%) a significant number of B-lines (≥15) was observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p<0.0001, r=0.76), left atrial volume (p<0.05, r=0.45) and PALS (p<0.05, r=0.5). However, we didn’t find any correlation between the number of B-lines and E/e’ ratio (p=0.1 r=0.28), or between E/e’ ratio and NT-proBNP levels (p=0.2 r=0.2).

Conclusions: Lung ultrasound is a simple and accessi-ble tool to detect pulmonary congestion in HFpEF. B-lines correlate well with NT-proBNP values and with new parameters of left atrial dysfunction. Furthermore, PALS reflected more accurately the pulmonary conges-tion and elevated NT-proBNP values than the E/e’ratio.