Diagnosing heart failure among acutely dyspneic patients with cardiac, inferior vena cava, and lung ultrasonography

• Published in: The American journal of emergency medicine 2013-08, Vol.31 (8), p.1208-1214
• Main Authors: Anderson, Kenton L., MD, Jenq, Katherine Y., MD, Fields, J. Matthew, MD, Panebianco, Nova L., MD, Dean, Anthony J., MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Dyspnea - diagnosis; Dyspnea - diagnostic imaging; Dyspnea - etiology; Echocardiography; Edema; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Heart failure; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - diagnostic imaging; Hospitals; Humans; Lung - diagnostic imaging; Male; Middle Aged; Mortality; Observational studies; Physicians; Prospective Studies; Sensitivity and Specificity; Stroke Volume; Vena Cava, Inferior - diagnostic imaging
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.05.007

Abstract Background Rapid diagnosis (dx) of acutely decompensated heart failure (ADHF) may be challenging in the emergency department (ED). Point-of-care ultrasonography (US) allows rapid determination of cardiac function, intravascular volume status, and presence of pulmonary edema. We test the diagnostic test characteristics of these 3 parameters in making the dx of ADHF among acutely dyspneic patients in the ED. Methods This was a prospective observational cohort study at an urban academic ED. Inclusion criteria were as follows: dyspneic patients, at least 18 years old and able to consent, whose differential dx included ADHF. Ultrasonography performed by emergency sonologists evaluated the heart for left ventricular ejection fraction (LVEF), the inferior vena cava for collapsibility index (IVC-CI), and the pleura sampled in each of 8 thoracic regions for presence of B-lines. Cutoff values for ADHF were LVEF less than 45%, IVC-CI less than 20%, and at least 10 B-lines. The US findings were compared with the final dx determined by 2 emergency physicians blinded to the US results. Results One hundred one participants were enrolled: 52% male, median age 62 (25%-75% interquartile, 53-91). Forty-four (44%) had a final dx of ADHF. Sensitivity and specificity (including 95% confidence interval) for the presence of ADHF were as follows: 74 (65-90) and 74 (62-85) using LVEF less than 45%, 52 (38-67) and 86 (77-95) using IVC-CI less than 20%, and 70 (52-80) and 75 (64-87) using B-lines at least 10. Using all 3 modalities together, the sensitivity and specificity were 36 (22-51) and 100 (95-100). As a comparison, the sensitivity and specificity of brain natriuretic peptide greater than 500 were 75 (55-89) and 83 (67-92). Conclusion In this study, US was 100% specific for the dx of ADHF.