Sonographic chest B-lines anticipate elevated B-type natriuretic peptide level, irrespective of ejection fraction

Abstract

BackgroundEchocardiography and the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) level are important tests for assessing left ventricular function in patients presenting to the emergency department with acute dyspnea. Chest ultrasound is becoming an important tool in diagnosing acute pulmonary edema.AimTo assess the diagnostic accuracy of chest ultrasound examination using echocardiography and a curvilinear probe for detecting B-lines in patients presenting with acute pulmonary edema compared with assessment using NT-proBNP.MethodsThis paper reports a prospective observational study of 61 consecutive patients presenting with symptoms and signs of pulmonary edema and B-profile detected by echocardiography with a 5 MHz curvilinear probe. The emergency department physicians ordered NT-proBNP levels, and critical care physicians trained in ultrasound examination performed echocardiography and chest ultrasounds. The findings of the chest ultrasound were reviewed by another senior physician.ResultsSixty-one participants were enrolled over a period of 6 months (49.2 % male, with a mean age 66.8). Forty-seven of the 61 patients had a B-profile. The median NT-proBNP level in the patients with B-profile was 6200, compared with the mean level in the patients with an A-profile of 180 (CI 0.33–0.82). The distributions in the two groups differed significantly (p = 0.034). Based on a threshold level of NT-proBNP in relation to age, the sensitivity and specificity (including the 95 % confidence interval) were determined; the sensitivity of finding B-profile on ultrasound was 92.0 %, and the specificity was 91.0 %. The positive predictive value of the B-profile was 97.0 %, and the negative predictive value was 71.0 %. The systolic function in the subjects with a B-profile was below 50 in 84.3 % of the subjects and normal in 15.7 % of the subjects. An A-profile was present in all of the subjects with systolic function >55 %. In the subjects with a B-profile, 94 % had a Framingham score of CHF >4; the subjects with all A-profile had scores <4, p < 0.0001. There was an NHANES score of >3 in 96 % of the subjects with a B-profile, and all of the subjects with an A-profile had scores <3 (p < 0.0001).ConclusionsDetecting the B-profile with an echocardiography probe (curvilinear 5 MHz) in lung ultrasound is highly sensitive and specific for elevated NT-proBNP helping in diagnosing pulmonary edema, although of resolution inferior to micro convex probes.

Lung ultrasound B‐lines in exacerbations of chronic obstructive pulmonary disease

“…These studies raise the need for tests that investigate the role of cardiac dysfunction in patients experiencing COPD exacerbations. Our study is consistent with previous studies on the utility of LUS in identifying patients with elevated NP in patients with heart failure, that is LUS B‐lines are specific (~90%) but the sensitivity is variable (30–90%) . In this study of patients with COPD exacerbations, we also found that LUS B‐lines have moderate sensitivity for identifying patients with elevated NP.…”

“…The pathognomonic feature on LUS used to diagnose cardiac failure is the identification of sonographic artefacts caused by extravascular lung water, thickening the lobular septa, called ‘B‐lines’ . Studies in cardiac failure patients have shown that LUS B‐lines are specific (90%) and sensitive (33–90%) for elevated NPs . Using LUS to identify cardiac failure is radiation‐free, typically takes 1 to 5 min to complete and has low inter and intra‐observer variability .…”

Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure

“…The major finding of our study corroborates and extends previous findings. 2 onstrated by point-of-care LUS display a very high specificity to support the diagnosis of AHF in ED patients with acute dyspnoea (specificity 75-91 %) [7,8]. In contrast to previous examinations, diagnostic sensitivity in our trial (40 %) is moderate as compared to previous reports (70 -92 %) [7,8].…”

“…2 onstrated by point-of-care LUS display a very high specificity to support the diagnosis of AHF in ED patients with acute dyspnoea (specificity 75-91 %) [7,8]. In contrast to previous examinations, diagnostic sensitivity in our trial (40 %) is moderate as compared to previous reports (70 -92 %) [7,8]. It is tempting to speculate that this may be due to the method of final adjudication of AHF diagnosis in respective trials: Final adjudicated diagnosis of AHF in our trial was done by 2 experienced physicians (cardiologist, emergency physician) using all available patient data for adjudication [1,10], while other reports used scores including descriptive methods of pulmonary congestions and/or cardiac decompensation for final diagnosis questioning accuracy of final adjudicated diagnosis [6,8].…”

Diagnostic value of brain natriuretic peptide and β-endorphin plasma concentration changes in patients with acute left heart failure and atrial fibrillation

“…This increases the plasma concentration of β-EP to 5 to 6 times. [ 10 – 12 ] β-EP is the main junction with opioid receptors and is involved in the pathological processes of many diseases, such as pain, breathing, circulation, digestion, and the hypothalamus-pituitary-target gland function, which play an important role. Its action mechanism mainly includes: the inhibition of catecholamine (CA) and prostaglandin (PG) on the regulation of cardiovascular function, inhibiting myocardial contraction force, the expansion of the capillaries, combined with capillary permeability of the blood, and bleeding that causes blood pressure to drop and shock; allow β-EP release to inhibit the respiratory center, reduce medulla, aorta, aortic sinus chemoreceptor sensitivity to hypoxia and hypercapnia, respiratory frequency and lower tidal volume, lessen ventilatory response caused by CO 2 , oxygen and CO 2 retention, leading to more β-EP released into the bloodstream, which is a vicious cycle, and increase in central inhibition; the role in brainstem reticular structure upward excited system and nonspecific thalamus cortex system, participate in the occurrence and development of brain dysfunction, and according to research, opioid receptors in the process of sensory afferent gate have an effect, which is caused by changes associated with EP.…”