AHF in the ED detected in 3 minutes by lung-and-echo POCUS

  • Öhman J & al.
  • Eur J Emerg Med
  • 1 abr. 2019

  • de Jenny Blair, MD
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • For patients with undifferentiated dyspnea in the emergency department (ED), a cardiothoracic point-of-care ultrasound (POCUS) protocol (CaTUS) that combines echocardiography and lung ultrasound accurately detects acute heart failure (AHF).
  • CaTUS took operator about 3 minutes.

Why this matters

  • The search continues for fast ways to differentiate AHF from other dyspnea.

Key results

  • 52 patients had AHF.
  • CaTUS performance:
    • Sensitivity: 100% (95% CI, 91.4%-100%).
    • Specificity: 95.8% (84.6%-99.3%).
    • Area under the curve: 0.979.
  • CaTUS outperformed both lung ultrasound and E/e’ alone.

Study design

  • Single-ED prospective observational study (n=100).
  • Convenience sample of adults with undifferentiated dyspnea underwent immediate bedside CaTUS followed by chest radiography, blood draw for brain natriuretic peptide (BNP), and conventional echocardiography.
  • CaTUS was considered positive in the presence of both:
    • E/e’ >15 on echocardiography, denoting elevated left atrial filling pressure, and 
    • Bilateral B-lines or bilateral pleural fluid on lung ultrasound, denoting congestion. 
  • CaTUS was compared with standard of either:
    • BNP >400 ng/L or 
    • BNP >100 ng/L plus congestion on chest radiography (masked radiologist review) plus structural heart disease on conventional echocardiography. 
  • Outcome: CaTUS performance in detecting AHF.
  • Funding: None disclosed.

Limitations

  • Small study with single experienced operator not fully masked to other patient data.