To investigate the clinical value of lung ultrasound in the volume management of patients with acute inferior wall and right ventricular myocardial infarction.

Totally 218 patients with acute inferior wall and right ventricular myocardial infarction and treated with emergency revascularization in the Department of Cardiology, Xuzhou Central Hospital from March 2016 to September 2018 were retrospectively analyzed. Based on whether they received bedside lung ultrasound and inferior vena cava ultrasound guidance therapy, patients were divided into a control group (n = 88) and an observation group (n = 130). Patients in the control group only performed echocardiography and other routine examinations, and patients in the observation group used lung ultrasound and inferior vena cava ultrasound on the basis of routine therapy. The general data, bedside echocardiography, lung ultrasound, inferior vena cava ultrasound, blood routine, biochemical terms, renal function changes and hospitalization time in the coronary care unit (CCU) were recorded for all patients. The correlation of ultrasound lung comets (ULCs), N-terminal pro-brain natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) was investigated by Spearman correlation analysis. The receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of ULCs, NT-proBNP and LVEF, and the area under the curve (AUC) was compared by the Z-test.

The ULCs and NT-proBNP were well correlated (r = 0.523, P < 0.001), while LVEF was poorly correlated with both NT-proBNP and ULCs (r = -0.352, -0.343; both P < 0.001). The ROC curve analysis showed that ULCs [AUC = 0.895, 95% confidence interval (CI) (0.829, 0.942), P < 0.001], NT-proBNP [AUC = 0.803, 95%CI (0.740, 0.866), P < 0.001] and LVEF [AUC = 0.683, 95%CI (0.617, 0.744), P < 0.001] had diagnostic value for heart failure in patients with acute inferior wall and right ventricular myocardial infarction; moreover, the AUC of ULCs was better than that of LVEF (Z = 3.604, P < 0.001) and NT-proBNP (Z = 1.249, P = 0.042). The use of furosemide [33.1% (43 / 130) vs. 54.5% (48 / 88), χ² = 9.946, P = 0.002] and its dose [60 (20, 60) mg vs. 60 (20, 100) mg, H = 2.082, P = 0.037], symptomatic heart failure [33.8% (44 / 130) vs. 54.5% (48 / 88), χ² = 9.218, P = 0.002], discharge creatinine [58 (48, 70) μmol / L vs. 67 (54, 86) μmol / L, H = 3.780, P < 0.001] and hospitalization time in the CCU [(3.2 ± 1.0) d vs. (3.6 ± 1.3) d, t = 2.728, P = 0.007] in the observation group were all significantly lower compared with those in the control group.

Lung ultrasound combined with inferior vena cava ultrasound and echocardiography can reduce the incidence of symptomatic heart failure, optimize volume management, reduce renal function damage and shorten length of stay in the CCU for patients with acute inferior wall and right ventricular myocardial infarction, which is worthy of wide promotion in the CCU.