Lung Ultrasound B-lines as a Surrogate Marker for High Left Ventricular Diastolic Pressures; a bed-side Diagnostic tool

Abdulaziz Aboshahba,Moaz Atef Elshahat Abdel Ati,Alsayed Ali Abdou Almarghany

doi:10.31579/2641-0419/217

Abdulaziz Aboshahba, Moaz Atef Elshahat Abdel Ati + Show 1 more

Open Access

https://doi.org/10.31579/2641-0419/217

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Abstract

Background: We studied the diagnostic accuracy of B-lines (comet-tail sign) on bedside lung US, NT-proBNP, E/e` on ECHO in differentiation of the causes of acute dyspnea in the emergency setting. Major advantages include bedside availability, no radiation, high feasibility and reproducibility, and cost efficiency. Methods: Our prospective study was performed at the alazhar university hospital, Cairo, Egypt, between July 2019 and March 2020. All patients underwent lung ultrasound examinations, along with TTE, laboratory testing, including rapid NT-proBNP testing. Results: The median E/e’ levels in patients with B-profile were 18, compared with a median of 7.4 in the subjects with A-profile (P =< 0.0001 CI = -9.649 to -7.044). It was found that the sensitivity and the specificity of detecting B-profile on ultrasound is high when E/e’ > 15.5 (95.0% and 83.0% consecutively), which concluded the high correlation between finding B profile on U/S chest and elevated left ventricle filling pressure in a patient presenting with picture of suggestive of heart failure Conclusion: Chest ultrasound can be used as screening test for the evaluation of patients with suspicion of heart failure with excellent sensitivity and good specificity.

Highlights

Acute pulmonary edema is a common problem facing emergency department (ED) physicians, and a percentage of these patients are admitted to the coronary care unit (CCU)
Chest ultrasound can be used as screening test for the evaluation of patients with suspicion of heart failure with excellent sensitivity and good specificity
Exclusion Criteria : We excluded ; o Patients did not give their consent to participate in the study o Patients with Lung ultrasound profile pattern other than A & B, o Patients with known chest disease as interstitial lung disease, pneumonia, Chronic obstructive pulmonary disease CVP (COPD) and Asthma. o Patients with mitral stenosis

Summary

Introduction

Acute pulmonary edema is a common problem facing emergency department (ED) physicians, and a percentage of these patients are admitted to the coronary care unit (CCU). The diagnosis of acute pulmonary edema remains a challenge for the following reasons: the presentation could be in combination with other diseases, such as chronic obstructive airway disease; and these diseases may have a presentation that is similar to that of acute pulmonary edema [1]. Chest ultrasound is used to detect subpleural interstitial edema lines (B-lines) and pleural effusion [1]. A B-line is a discrete, laser-like, vertical, hyperechoic image that arises from the pleural line. The B-lines are useful for the diffrential diagnosis of cardiogenic versus non-cardiogenic dyspnea [2]. We studied the diagnostic accuracy of B-lines (comet-tail sign) on bedside lung US, NT-proBNP, E/eon ECHO in differentiation of the causes of acute dyspnea in the emergency setting. Major advantages include bedside availability, no radiation, high feasibility and reproducibility, and cost efficiency

Objectives

Methods

Conclusion