Author + information
- Luna Gargani, MD,
- Rossella Raso, Eng, PhD∗ (, )
- Gennaro Tartarisco, Eng, PhD,
- Marco Matucci Cerinic, MD, PhD,
- Giovanni Pioggia, Eng, PhD and
- Eugenio Picano, MD, PhD
- ↵∗CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124, Pisa, Italy
We thank Drs. Trovato and Sperandeo for their indefatigable interest in our work (1).
We understand that the artefactual nature of B-lines may arouse skepticism. However, there is a large body of clinical and experimental evidence from many different groups showing that multiple B-lines are present when the pulmonary interstitium is involved in a pathological process and are absent in a normal lung. Recently, they have also been included in European recommendation papers (2,3). We agree that the underlying biophysical model is not yet fully understood, but the clinical usefulness of this sign is by now proven. After all, physicians successfully used nitrates for decades to treat angina, despite being unaware of nitric oxide and its specific physiological mechanisms.
As stated in many papers, it is not only the mere presence of B-lines that defines a positive evaluation. We agree and have previously reported that a few B-lines, especially at pulmonary bases, can be found in normal subjects (4). In the case of pulmonary interstitial syndrome, B-lines are multiple and diffuse in the thorax, and if the etiology is systemic such as in heart failure, they are bilateral. These characteristics are very helpful for differentiating pathological conditions from those in healthy subjects. It has also been reported that there are some limitations of the technique (4): patients with pneumonectomy fall into this group.
To establish a diagnosis of heart failure or pulmonary fibrosis, we considered all clinical and instrumental information available. Some of these parameters are more “objective” (i.e., N-terminal pro–B-type natriuretic peptide), some are less “objective” (i.e., pulmonary auscultation). All parameters share an accuracy that is never 100%, with false positives and false negatives to be identified by the integration of different data in a multiparametric approach. This is why we always perform pulmonary auscultation, but we know that we cannot rely only on auscultatory findings, given the low sensitivity and specificity for most conditions (5).
We believe that diagnosis should not be made on the basis of a single examination, but by integrating anamnestic, clinical, and instrumental findings.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2015 American College of Cardiology Foundation
- Raso R.,
- Tartarisco G.,
- Matucci Cerinic M.,
- Pioggia G.,
- Picano E.,
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- Mebazaa A.,
- Yilmaz M.B.,
- Levy P.,
- et al.
- Gheorghiade M.,
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- et al.