Lung Ultrasound Eight-Point Method in Diagnosing Acute Heart Failure in Emergency Patients with Acute Dyspnea: Diagnostic Accuracy and 72 h Monitoring.

Erika Glöckner,Alexander Dechêne,Katrin Singler,Michael Christ,Felicitas Wening

doi:10.3390/medicina56080379

Abstract

Background and Objectives: Acute dyspnea is a common chief complaint in the emergency department (ED), with acute heart failure (AHF) as a frequent underlying disease. Early diagnosis and rapid therapy are highly recommended by international guidelines. This study evaluates the accuracy of point-of-care B-line lung ultrasound in diagnosing AHF and monitoring the therapeutic success of heart failure patients. Materials and Methods: This is a prospective mono-center study in adult patients presenting with undifferentiated acute dyspnea to a German ED. An eight-zone pulmonary ultrasound was performed by experienced sonographers in the ED and 24 and 72 h after. Along with the lung ultrasound evaluation patients were asked to assess the severity of shortness of breath on a numeric rating scale. The treating ED physicians were asked to assess the probability of AHF as the underlying cause. Final diagnosis was adjudicated by two independent experts. Follow-up was done after 30 and 180 days. Results: In total, 102 patients were enrolled. Of them, 89 patients received lung ultrasound evaluation in the ED. The sensitivity of lung ultrasound evaluation in ED in diagnosing AHF was 54.2%, specificity 97.6%. As much as 96.3% of patients with a positive LUS test result for AHF in ED actually suffered from AHF. Excluding diuretically pretreated patients, sensitivity of LUS increased to 75% in ED. Differences in the sum of B-lines between admission time point, 24 and 72 h were not statistically significant. There were no statistically significant differences in the subjectively assessed severity of dyspnea between AHF patients and those with other causes of dyspnea. Of the 89 patients, 48 patients received the final adjudicated diagnosis of AHF. ED physicians assessed the probability of AHF in patients with a final diagnosis of AHF as 70%. Roughly a quarter (23.9%) of the overall cohort patients were rehospitalized within 30 days after admission, 38.6% within 180 days of follow-up. Conclusion: In conclusion, point-of-care lung ultrasound is a helpful tool for the early rule-in of acute heart failure in ED but only partially suitable for exclusion. Of note, the present study shows no significant changes in the number of B-lines after 24 and 72 h.

Highlights

Acute dyspnea is a common chief complaint in patients presenting to the emergency department (ED) and is associated with high morbidity and mortality
Median age of patients who received Lung ultrasound (LUS) measurement in ED was 73 years, 62% of them had Median age of patients who received LUS measurement in ED was 73 years, 62% of them had a a previous history of heart failure and 71% of hypertension (Table 1). 48 of 89 patients received the previous history of heart failure and 71% of hypertension (Table 1). 48 of 89 patients received the final final adjudicated diagnosis of acute heart failure (AHF), 41 patients suffered from other diseases adjudicated diagnosis of acute heart failure (AHF), 41 patients suffered from other diseases
B-lines of patients decreased over time from initially from prehospital scene (Table 5): we found a higher sensitivity (75% vs. 54.2% diuretically pretreated) and 14 to 12 after 24 h (p = 0.636) and to 9 after 72 h (p = 0.880), NT-proBNP from 3912 pg/mL to negative predictive value (83.3% vs. 64.5% diuretically pretreated)

Summary

Introduction

About 50% of adult dyspnoeic patients display acute heart failure (AHF) [1]. Lung ultrasound (LUS) is a non-invasive tool for the evaluation of patients with shortness of breath. Point of care ultrasound is a fast method of bedside evaluation of patients in the emergency room and suitable for the examination of patients with acute shortness of breath. Acute dyspnea is a common chief complaint in the emergency department (ED), with acute heart failure (AHF) as a frequent underlying disease. This study evaluates the accuracy of point-of-care B-line lung ultrasound in diagnosing AHF and monitoring the therapeutic success of heart failure patients. Along with the lung ultrasound evaluation patients were asked to assess the severity of shortness of breath on a numeric rating scale.

Methods

Results

Discussion

Conclusion