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

Abstract

IntroductionWe studied the diagnostic accuracy of bedside lung ultrasound (the presence of a comet-tail sign), N-terminal pro-brain natriuretic peptide (NT-proBNP) and clinical assessment (according to the modified Boston criteria) in differentiating heart failure (HF)-related acute dyspnea from pulmonary (chronic obstructive pulmonary disease (COPD)/asthma)-related acute dyspnea in the prehospital setting.MethodsOur prospective study was performed at the Center for Emergency Medicine, Maribor, Slovenia, between July 2007 and April 2010. Two groups of patients were compared: a HF-related acute dyspnea group (n = 129) and a pulmonary (asthma/COPD)-related acute dyspnea group (n = 89). All patients underwent lung ultrasound examinations, along with basic laboratory testing, rapid NT-proBNP testing and chest X-rays.ResultsThe ultrasound comet-tail sign has 100% sensitivity, 95% specificity, 100% negative predictive value (NPV) and 96% positive predictive value (PPV) for the diagnosis of HF. NT-proBNP (cutoff point 1,000 pg/mL) has 92% sensitivity, 89% specificity, 86% NPV and 90% PPV. The Boston modified criteria have 85% sensitivity, 86% specificity, 80% NPV and 90% PPV. In comparing the three methods, we found significant differences between ultrasound sign and (1) NT-proBNP (P < 0.05) and (2) Boston modified criteria (P < 0.05). The combination of ultrasound sign and NT-proBNP has 100% sensitivity, 100% specificity, 100% NPV and 100% PPV. With the use of ultrasound, we can exclude HF in patients with pulmonary-related dyspnea who have positive NT-proBNP (> 1,000 pg/mL) and a history of HF.ConclusionsAn ultrasound comet-tail sign alone or in combination with NT-proBNP has high diagnostic accuracy in differentiating acute HF-related from COPD/asthma-related causes of acute dyspnea in the prehospital emergency setting.Trial registrationClinicalTrials.gov NCT01235182.

Sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema: a systematic review and meta-analysis

“…Only one study was a case-control study, while the others were prospective cohort studies. Four studies followed the procedure reported by Volpicelli et al [10,[14][15][16]18]. Two studies diagnosed the PE by detecting B-line in anterior and lateral chest and three or more B-lines in at least two zones on each hemithorax [12,13].…”

“…After removing the duplicate studies and the studies that did not fulfill the inclusion criteria, 8 studies were included in the meta-analysis (1301 patients; Table I) [10][11][12][13][14][15][16][17]. Two studies were performed in the ICU, three studies in the ED, two studies in the ward and one study in a pre-hospital setting and ED.…”

Utilidad de la ecografía clínica en el diagnóstico del paciente con disnea

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Association between B-lines detected during lung ultrasound and various factors in hemodialysis patients

“…An intercostal scan with maximum extension of the visual pleural line was performed. The chest wall was divided into eight areas (two anterior and two lateral areas per side), and two scan was obtained for each area [22][23][24][25][26]. The anterior zone of the chest wall was designated from the sternum to the anterior axillary line and was then divided into upper and lower halves (from the clavicle to the third intercostal spaces and from the third space to the diaphragm).…”