Objective To assess the value of the modified 4-zone lung ultrasonography (LUS) for predicting death or return to intensive care units (ICUs) within 3 months in patients with acute heart failure admitted to the EICU.Methods Retrospective inclusion of patients with acute heart failure diagnosed in the EICU of Zigong Fourth People's Hospital from February 7, 2018 to May 22, 2020 were used as the poor prognosis group and endpoint index. Death or return to ICUs within 3 months was used as the end point. To calculate adjusted odds ratios for predicting outcome by different lung ultrasound scores. Analyze the area under curve(AUC), net reclassification improvement(NRI), and integrated discrimination improvement(IDI) of the 4-zone LUS、the modified 4-zone LUS and the 8-zone LUS. The calibration and decision curves were drawn to evaluate the degree of calibration and clinical utility. Results Among the 71 patients with acute heart failure who met the study conditions, and 37(52.11%) death or return to ICUs within 3 months. The AUC value of the 4-zone LUS was 0.601, the AUC value of the modified 4-zone LUS was 0.679, and the AUC value of the 8-zone LUS was 0.717. Compared with the 4-zone LUS, the modified 4-zone LUS (NRI=0.700, P=0.002; IDI=0.088, P=0.006) and 8-zone LUS (NRI=0.719, P=0.001; IDI=0.095, P=0.008) both showed a positive improvement in predictive ability. The 8-zone LUS was the best in calibration degree, followed by the modified 4-zone LUS, and the 4-zone LUS was the worst. Clinical Practicality the modified 4-zone LUS and the 8-zone LUS were better, while the 4-zone LUS was worse. Conclusion The modified 4-zone LUS is more valuable than the 4-zone LUS in predicting death or readmission within 3 months in patients with acute heart failure