Ultrasound lung comet images (ULC) are useful for the noninvasive assessment of 
extravascular lung water (EVLW). We investigated the modification of EVLW, its 
relation to indices of left ventricular systolic and diastolic function, and 
noninvasively determined pulmonary capillary wedge pressure (PCWP) (PCWP = 1.24 
ratio of early diastolic mitral inflow velocity to early diastolic velocity of 
the mitral annulus [E/Em] + 1.9) at rest and its variation during exercise 
echocardiography. A total of 72 patients (mean age 66.4 +/- 8.4 years) with mean 
ejection fraction of 41.2 +/- 14.4% underwent symptoms-limited exercise 
echocardiography. The sum of the ULC yielded a score of EVLW. The ULC increased 
significantly from baseline to postexercise (5.9 +/- 14.9 vs 11 +/- 20.7, P = 
.0001). Positive linear correlations were found between baseline ULC score and 
baseline ejection fraction (r = -0.37, P = .002), systolic pulmonary artery 
pressure (r = 0.69, P = .0001), E/Em (r = 0.70, P = .0001), and estimated PCWP 
(r = 0.69, P = .0001). The variation between postexercise and baseline ULC score 
correlated significantly with the variation between peak stress and rest PCWP (r 
= 0.62, P = .0001), systolic pulmonary artery pressure (r = 0.44, P = .0001), 
wall-motion score index (r = 0.30, P = .01), and peak stress E/Em (r = 0.71, P = 
.0001), whereas no significant correlations were found between variations of ULC 
score and ejection fraction. This study shows that ULC represents a simple way 
to assess the presence of excess EVLW. Increased EVLW is associated with 
estimated PCWP and indices of left ventricular systolic and diastolic 
dysfunction. The additional exercise-induced increase of PCWP, the worsening of 
left ventricular diastolic function, and extensive wall-motion abnormalities 
correlate with variations of EVLW.