The online version of this article (doi:10.1186/1476-7120-10-49) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
KK, TN, and TA conceived this study. KK and KM performed lung-cardiac-inferior vena cava ultrasound in patients with acute dyspnea. KK, HT, and TK participated in the study design and coordination an helped to draft the manuscript. All authors read and approved the final manuscript.
Rapid and accurate diagnosis and management can be lifesaving for patients with acute dyspnea. However, making a differential diagnosis and selecting early treatment for patients with acute dyspnea in the emergency setting is a clinical challenge that requires complex decision-making in order to achieve hemodynamic balance, improve functional capacity, and decrease mortality. In the present study, we examined the screening potential of rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating acute heart failure syndromes (AHFS) from primary pulmonary disease in patients with acute dyspnea in the emergency setting.
Between March 2011 and March 2012, 90 consecutive patients (45 women, 78.1 ± 9.9 years) admitted to the emergency room of our hospital for acute dyspnea were enrolled. Within 30 minutes of admission, all patients underwent conventional physical examination, rapid ultrasound (lung-cardiac-inferior vena cava [LCI] integrated ultrasound) examination with a hand-held device, routine laboratory tests, measurement of brain natriuretic peptide, and chest X-ray in the emergency room.
The final diagnosis was acute dyspnea due to AHFS in 53 patients, acute dyspnea due to pulmonary disease despite a history of heart failure in 18 patients, and acute dyspnea due to pulmonary disease in 19 patients. Lung ultrasound alone showed a sensitivity, specificity, negative predictive value, and positive predictive value of 96.2, 54.0, 90.9, and 75.0%, respectively, for differentiating AHFS from pulmonary disease. On the other hand, LCI integrated ultrasound had a sensitivity, specificity, negative predictive value, and positive predictive value of 94.3, 91.9, 91.9, and 94.3%, respectively.
Our study demonstrated that rapid evaluation by LCI integrated ultrasound is extremely accurate for differentiating acute dyspnea due to AHFS from that caused by primary pulmonary disease in the emergency setting.
Logeart D, Saudubray C, Beyne P, Thabut G, Ennezat PV, Chavelas C, Zanker C, Bouvier E, Solal AC: Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol. 2002, 40: 1794-1800. 10.1016/S0735-1097(02)02482-8 CrossRefPubMed
Liteplo AS, Marill KA, Villen T, Miller RM, Murray AF, Croft PE, Capp R, Noble VE: Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med. 2009, 16: 201-210. 10.1111/j.1553-2712.2008.00347.x CrossRefPubMed
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T: International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012, 38: 577-591. 10.1007/s00134-012-2513-4 CrossRefPubMed
Copetti R, Soldati G, Copetti P: Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008, 29;6: 16-25. CrossRef
Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K: Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010, 23: 1225-1230. 10.1016/j.echo.2010.10.005 CrossRefPubMed
Vourvouri EC, Schinkel AF, Roelandt JR, Boomsma F, Sianos G, Bountioukos M, Sozzi FB, Rizzello V, Bax JJ, Karvounis HI, Poldermans D: Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device. Eur J Heart Fail. 2003, 5: 767-774. 10.1016/S1388-9842(03)00155-7 CrossRefPubMed
Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, Hochadel M, Komajda M, Lassus J, Lopez-Sendon JL, Ponikowski P, Tavazzi L, EuroHeart Survey Investigators: Heart Failure Association, European Society of Cardiology. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006, 27: 2725-2736. 10.1093/eurheartj/ehl193 CrossRefPubMed
Mintz GS, Kotler MN, Parry WR, Iskandrian AS, Kane SA: Real-time inferior vena caval ultrasonography: normal and abnormal findings and its use in assessing right-heart function. Circualtion. 1981, 64: 1018-1025. 10.1161/01.CIR.64.5.1018. CrossRef
Kircher BJ, Himelman RB, Schiller NB: Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1995, 66: 493-496. CrossRef
Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, Maury E, Slama M, Vignon P: American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest. 2009, 135: 1050-1060. 10.1378/chest.08-2305 CrossRefPubMed
Cardim N, Fernandez Golfin C, Ferreira D, Aubele A, Toste J, Cobos MA, Carmelo V, Nunes I, Oliveira AG, Zamorano J: Usefulness of a new miniaturized echocardiographic system in outpatient cardiology consultations as an extension of physical examination. J Am Soc Echocardiogr. 2011, 24: 117-124. 10.1016/j.echo.2010.09.017 CrossRefPubMed
Prosen G, Klemen P, Štrnad M, Grmec S: Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting. Crit Care. 2011, 15: R114-R122. 10.1186/cc10140 CrossRefPubMedPubMedCentral
Nosir YFM, Vletter WB, Boersma E, Frowijin R, Cate FJT, Fioretti PM, Roelandt JRTC: The apical long-axis rather than the two-chamber view should be used in combination with the four-chamber view for accurate assessment of left ventricular volumes and function. Eur Heart J. 1997, 18: 1175-1185. 10.1093/oxfordjournals.eurheartj.a015414 CrossRefPubMed
Chen AA, Wood MJ, Krauser DG, Baggish AL, Tung R, Anwaruddin S, Picard MH, Januzzi JL: NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: results from the ProBNP Investigation of Dyspnoea in the Emergency Department (PRIDE) echocardiographic substudy. Eur Heart J. 2006, 27: 839-845. 10.1093/eurheartj/ehi811 CrossRefPubMed
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB: Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010, 23: 685-713. 10.1016/j.echo.2010.05.010 CrossRefPubMed
Goonewardena SN, Gemignani A, Ronan A, Vasaiwala S, Blair J, Brennan JM, Shah DP, Spencer KT: Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure. JACC Cardiovasc Imaging. 2008, 1: 595-601. 10.1016/j.jcmg.2008.06.005 CrossRefPubMed
Weintraub NL, Collins SP, Pang PS, Levy PD, Anderson AS, Arslanian-Engoren C, Gibler WB, McCord JK, Parshall MB, Francis GS, Gheorghiade M: Acute heart failure syndromes: emergency department presentation, treatment, and disposition: current approaches and future aims: a scientific statement from the American Heart Association. Circulation. 2010, 122: 1975-1996. 10.1161/CIR.0b013e3181f9a223 CrossRefPubMed
Knudsen CW, Omland T, Clopton P, Westheim A, Abraham WT, Storrow AB, McCord J, Nowak RM, Aumont MC, Duc P, Hollander JE, Wu AH, McCullough PA, Maisel AS: Diagnostic value of B-Type natriuretic peptide and chest radiographic findings in patients with acute dyspnea. Am J Med. 2004, 116: 363-368. 10.1016/j.amjmed.2003.10.028 CrossRefPubMed
Singer AJ, Birkhahn RH, Guss D, Chandra A, Miller CD, Tiffany B, Levy P, Dunne R, Bastani A, Thode HC, Hollander JE: Rapid Emergency Department Heart Failure Outpatients Trial (REDHOT II): a randomized controlled trial of the effect of serial B-type natriuretic peptide testing on patient management. Circ Heart Fail. 2009, 2: 287-293. 10.1161/CIRCHEARTFAILURE.108.826685 CrossRefPubMed
Lokuge A, Lam L, Cameron P, Krum H, de Villiers S, Bystrzycki A, Naughton MT, Eccleston D, Flannery G, Federman J, Schneider HG: B-type natriuretic peptide testing and the accuracy of heart failure diagnosis in the emergency department. Circ Heart Fail. 2010, 3: 104-110. 10.1161/CIRCHEARTFAILURE.109.869438 CrossRefPubMed
- Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II