Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: A comparison with natriuretic peptides☆

Abstract

Background: Acute dyspnoea as a presenting symptom is a frequent diagnostic challenge for physicians. The main differential diagnosis is between dyspnoea of cardiac and non-cardiac origin. Natriuretic peptides have been shown to be useful in this setting. Ultrasound lung comets (ULCs) are a simple, echographic method which can be used to assess pulmonary congestion. Aim: To evaluate the accuracy of ULCs for predicting dyspnoea of cardiac origin compared to natriuretic peptides. Methods: We evaluated 149 patients admitted with acute dyspnoea. Chest sonography and NT-proBNP assessments were performed a maximum of 4 h apart and independently analyzed. ULCs were evaluated via cardiac probes placed on the anterior and lateral chest. Two independent physicians, blinded to ULCs and NT-proBNP findings, reviewed all the medical records to establish the aetiologic diagnosis of dyspnoea. Results: Cardiogenic dyspnoea was confirmed in 122 patients and ruled-out in 27 patients. The number of ULCs was significantly correlated to NT-proBNP values (r = .69, p b .0001). Receiver operating characteristic analysis, showed an area under the curve of .893 for ULCs and .978 ( p = .001) for NT-proBNP, in predicting the cardiac origin of dyspnoea. Conclusions: In patients admitted with acute dyspnoea, pulmonary congestion, sonographically imaged as ULCs, is significantly correlated to NT-proBNP values. The accuracy of ULCs in predicting the cardiac origin of dyspnoea is high.

Sonographic Interstitial Syndrome

“…4,7,19,20 Inclusion and Exclusion Criteria To be included in the study and analyzed, the images had to pertain to patients who had the following: (1) radiographic evidence of pulmonary edema or imbibition; (2) clinical and physiologic documentation of the cause (hydrostatic or lesional) of the pulmonary edema, including an echocardiographic study of left ventricular function; and (3) a CT study within the course of their hospital stay, with the exception of neonates. Images of patients that did not meet the inclusion criteria and those of patients with chronic pneumogenic interstitial syndrome (lung fibrosis or flogistic or granulomatous interstitial disease) were excluded.…”

Bedside Evaluation of Critical Dyspnea. Proposal of a Diagnostic Score for Acute Heart Failure in Emergency Setting

“…Many studies compared LUS to other diagnostic tools [42,43] but our scoring model suggests an integrated and operative approach to patients with acute onset shortness of breath.…”

Lung ultrasound in heart failure: Lessons from re‐analysis of Lung Ultrasound 2011 database

“…– 10 They were examined with an 8 view LUS protocol (adapted from Volpicelli 11 )) and bedside and then blinded interpretation of still images were recorded and compared against chart review. Our overall diagnostic accuracy for identifying pulmonary oedema was 85% – an improvement on conventional practice but seemingly mediocre when compared with other sonographic studies examined in a recent meta analysis 1 …”