Objective:

To evaluate whether combining lung ultrasound B-lines, NT-proBNP levels, and left atrial volume index (LAVI) can improve bedside identification of heart failure with preserved ejection fraction (HFpEF), which is crucial for timely and effective patient management.

Key Findings:

• 57 patients had HFpEF and 163 had non-HFpEF.
• Individual markers had limited-to-moderate discriminatory ability: AUCs of 0.680 for B-line score, 0.655 for NT-proBNP, and 0.550 for LAVI, indicating their moderate effectiveness in distinguishing HFpEF.
• The combined model of B-line score, NT-proBNP, and LAVI achieved an AUC of 0.737 with 71.9% sensitivity and 69.3% specificity.
• The full exploratory model increased AUC to 0.765.
• Combined models provided greater net benefit than treat-all and treat-none strategies.

Interpretation:

The combination of lung ultrasound B-lines, NT-proBNP, and LAVI demonstrates moderate ability to distinguish HFpEF from non-HFpEF in acute heart failure patients, serving as a bedside phenotype-characterization tool with potential implications for clinical practice.

Limitations:

• Single-center study may limit generalizability and introduce potential biases.
• Study design does not provide a validated diagnostic model for HFpEF.

Conclusion:

The study suggests that integrating lung ultrasound B-lines, NT-proBNP, and LAVI may improve bedside identification of HFpEF, but further validation is needed to confirm these findings in broader populations.