Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed.

Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting.

Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death.

Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at >15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 (p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p < 0.001).

Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.

背景：射血分数保留的心力衰竭 (HFpEF) 是一个日益严重的医疗负担，其患病率正在稳步上升。肺超声 (LUS) 是一种很有前途的心力衰竭人群筛查和预后工具。然而，需要更多关于其在预测结果方面的价值的信息。

目标： 我们研究的目的是评估 LUS B 线与传统和新的临床和超声心动图参数以及非卧床环境中新诊断的 HFpEF 患者的利钠肽水平相比的预后性能。

方法：在我们的前瞻性队列研究中，所有临床疑似 HFpEF 的门诊患者在我们的心脏病门诊首次就诊时均接受了全面的超声心动图、肺部超声和 NT-proBNP 测量。我们的终点是需要住院或袢利尿剂剂量递增的心力衰竭症状恶化和死亡的复合终点。

结果：我们前瞻性地招募了 75 名符合我们纳入和排除标准的 HFpEF 患者。我们在 26 ± 10 个月的随访中检测到 11 个事件。我们发现 B 线的预测值与 NT-proBNP 的预测值相似（AUC 0.863 对 0.859），最佳截止值是 >15 B 线。B 线多于 15 显着增加了不良事件的可能性，风险比为 20.956（p= 0.004）。B 线的数量仍然是多变量建模中事件的独立预测因子。超过 15 条 B 线与显着更差的无事件生存相关（对数秩：16.804，p < 0.001)。

结论：B 线的数量似乎是 HFpEF 不良结局的独立预后因素。由于它是一种易于学习、可行且无辐射的方法，它可以为常用的诊断和风险分层模型增加实质性的价值。