Accuracy of chest radiographs in the emergency diagnosis of heart failure

Abstract

The purpose of this study was to determine the diagnostic accuracy of chest radiographic findings of heart failure (HF) in current patients presenting with dyspnea in the emergency department. In a secondary analysis of the BASEL study, initial chest radiographs of 277 patients with acute dyspnea were evaluated by two radiologists blinded to the adjudicated diagnosis (56% had the final diagnosis of HF). Predefined radiographic criteria of HF were used. Statistical analysis included receiver-operating characteristic (ROC) analysis and calculation of a logistic regression model including B-type natriuretic peptide (BNP) levels. The reader's overall impression showed the highest area under the ROC curve for the diagnosis of HF in both supine and erect patient positions (0.855 and 0.857). Among individual radiographic findings, peribronchial cuffing in the supine position (0.829) showed the highest accuracies. The lowest accuracy was found for the vascular pedicle width in the supine position (0.461). Logistic regression analysis showed no significant differences between the reader's overall impression, the radiographic model, and BNP testing. In our study, the combination of radiographic features provided valuable information and was of comparable accuracy as BNP-testing for the diagnosis of HF.

Comparison of a basic lung scanning protocol against formally reported chest x‐ray in the diagnosis of pulmonary oedema

“…Although our reference test may have been influenced by the radiologist report, it was only one factor in the auditor's diagnostic synthesis. Both the BASEL 2 , 8 and the Breathing Not Properly 4 , 9 studies appear unblinded in this same respect, meaning that our estimates are comparable and we assume the improvement can be attributed to the paired sample effect.…”

“…When experts reviewed the BASEL chest x‐rays, with forewarning, reporting ‘probable heart failure’ using a specific tool, sensitivity and specificity improved to give an overall test accuracy with an area under ROC between 0.855 and 0.857, although for the data points tabulated, a diagnostic accuracies of 79.7% and 78.2% can be inferred, the difference due to patient positioning 2 . These results pertain to groups with a higher rate of heart failure (51%).…”

“…, 2 For this reason, many people who present with breathlessness require more complex investigation to determine its cause. Specific clinical and radiographic signs of heart failure are rare 1 – 5 so patients undergo a barrage of tests with mediocre precision.…”

“…Not surprisingly, clinicians are examining low cost modalities that improve diagnostic precision, in particular B‐type natriuretic peptide 2 , 9 , 12 , 13 and bedside lung ultrasound 12 14 – 21 The first lung ultrasound studies (LUS) were conducted in intensive care on patients with pulmonary oedema of various aetiologies, and aimed to identify radiographic changes labelled ‘alveolar interstitial syndrome’ 22 …”

“…, 14 – 21 The first lung ultrasound studies (LUS) were conducted in intensive care on patients with pulmonary oedema of various aetiologies, and aimed to identify radiographic changes labelled ‘alveolar interstitial syndrome’ 22 24 Lung ultrasound for interstitial syndrome produced sensitivities and specificities 15 ,, 17 , 21 , 22 , 25 that suggested it may surpass chest x‐ray 2 4 , 7 – 9 Some research groups now recommend that a negative lung scan protocol be used as a screening tool to reduce redundant chest x‐ray in breathless patients 16 …”