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Background Pulmonary congestion quantification is essential for follow-up of heart failure (HF). Most available tools are inaccurate or invasive. Hence, ultrasonographic B-line modes have been suggested as an alternative easy noninvasive diagnostic instrument for pulmonary congestion evaluation in patients with HF. Aim The aim was to assess the lung ultrasound role in evaluating HF in patients with preserved ejection fraction (EF). Patients and methods A total of 150 participants admitted to the cardiovascular department or followed in the outpatient clinic between July 2016 and May 2017 were included in this study. The participants were divided into five groups (each 30 patients): patients with HF having preserved EF (HFpEF) without comorbidities, patients with HFpEF with comorbidities, HF patients with midrange EF (HFmrEF) without comorbidities, patients with HFmrEF with comorbidities, and nondiabetic nonhypertensive individuals. All groups were subjected to New York Heart Association grading for cardiac diseases, echocardiography, and serum brain natriuretic peptide assessment. Results B-lines significantly increased with increased New York Heart Association class. A negative correlation was found between B-lines and the EF% (r=−0.46). The brain natriuretic peptide and B-lines showed a significant, powerful association in the first group (r=0.81), the second group (r=0.80), the third group (r=0.85), and the fourth group (r=0.098), but there was an inverse insignificant correlation in the control. Conclusion B-line assessment by lung ultrasound is considered a simple tool for the evaluation of pulmonary congestion resulting from diastolic HF (HFPEF). It can be used as a fast and reliable tool.