Acute heart failure: new diagnostic perspectives for the emergency physician

Soldati, Gino; Gargani, Luna; Silva, Fernando R.

doi:10.1007/s11739-008-0114-6

Cited by 14 publications

(11 citation statements)

References 40 publications

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“…Although other studies have previously evaluated US accuracy for the diagnosis of cardiogenic dyspnea, no data are currently available on the accuracy of PLUS performed early in the ED setting. In our study, we find that the detection of diffuse AIS by PLUS is highly predictive for cardiogenic dyspnea, confirming the results of previous studies performed in different clinical settings [5,6,9,12]. Positive and negative LR values make this sonographic finding a rule-in and rule-out test.…”

Section: Discussionsupporting

confidence: 90%

Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the Emergency Department

et al. 2011

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Dyspnea is a common symptom in patients admitted to the Emergency Department (ED), and discriminating between cardiogenic and non-cardiogenic dyspnea is often a clinical dilemma. The initial diagnostic work-up may be inaccurate in defining the etiology and the underlying pathophysiology. The aim of this study was to evaluate the diagnostic accuracy and reproducibility of pleural and lung ultrasound (PLUS), performed by emergency physicians at the time of a patient's initial evaluation in the ED, in identifying cardiac causes of acute dyspnea. Between February and July 2007, 56 patients presenting to the ED with acute dyspnea were prospectively enrolled in this study. In all patients, PLUS was performed by emergency physicians with the purpose of identifying the presence of diffuse alveolar-interstitial syndrome (AIS) or pleural effusion. All scans were later reviewed by two other emergency physicians, expert in PLUS and blinded to clinical parameters, who were the ultimate judges of positivity for diffuse AIS and pleural effusion. A random set of 80 recorded scannings were also reviewed by two inexperienced observers to assess inter-observer variability. The entire medical record was independently reviewed by two expert physicians (an emergency medicine physician and a cardiologist) blinded to the ultrasound (US) results, in order to determine whether, for each patient, dyspnea was due to heart failure, or not. Sensitivity, specificity, and positive/negative predictive values were obtained; likelihood ratio (LR) test was used. Cohen's kappa was used to assess inter-observer agreement. The presence of diffuse AIS was highly predictive for cardiogenic dyspnea (sensitivity 93.6%, specificity 84%, positive predictive value 87.9%, negative predictive value 91.3%). On the contrary, US detection of pleural effusion was not helpful in the differential diagnosis (sensitivity 83.9%, specificity 52%, positive predictive value 68.4%, negative predictive value 72.2%). Finally, the coexistence of diffuse AIS and pleural effusion is less accurate than diffuse AIS alone for cardiogenic dyspnea (sensitivity 81.5%, specificity 82.8%, positive predictive value 81.5%, negative predictive value 82.8%). The positive LR was 5.8 for AIS [95% confidence interval (CI) 4.8-7.1] and 1.7 (95% CI 1.2-2.6) for pleural effusion, negative LR resulted 0.1 (95% CI 0.0-0.4) for AIS and 0.3 (95% CI 0.1-0.8) for pleural effusion. Agreement between experienced and inexperienced operators was 92.2% (p < 0.01) and 95% (p < 0.01) for diagnosis of AIS and pleural effusion, respectively. In early evaluation of patients presenting to the ED with dyspnea, PLUS, performed with the purpose of identifying diffuse AIS, may represent an accurate and reproducible bedside tool in discriminating between cardiogenic and non-cardiogenic dyspnea. On the contrary, US detection of pleural effusions does not allow reliable discrimination between different causes of acute dyspnea in unselected ED patients.

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Section: Discussionsupporting

confidence: 90%

Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the Emergency Department

et al. 2011

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“…Unlike the natriuretic peptides, however, few of these biomarkers have been rigorously tested in the acute setting and their prospective clinical role, if any, is unclear. Other modalities such as electronic detection of third heart sounds (S 3 ) using acoustic cardiography, 170 -172 noninvasive hemodynamic profiling using impedance cardiography, 173,174 bedside portable chest ultrasound to evaluate for accumulated interstitial lung fluid, [175][176][177] and quantitative capnometry 178 have been investigated as both stand-alone and adjunct diagnostic measures, but appear to provide little benefit over existing approaches. Cardiovascular response to the Valsalva maneuver has been proposed as an additional method by which ventricular filling pressures and volume status can be assessed 179,180 but its utility in AHFS management has not been well-defined.…”

Section: Novel Diagnosticsmentioning

confidence: 99%

Acute Heart Failure Syndromes: Emergency Department Presentation, Treatment, and Disposition: Current Approaches and Future Aims

Weintraub¹,

Collins²,

Pang³

et al. 2010

Circulation

248

189

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“…The presence of lung consolidation is suggestive of pulmonary contusion with a sensitivity and NPV of 18.9 and 63 %, respectively, while diagnostic accuracy is 65.9 % and specificity and PPV rise to 100 % [42]. In the normal lung, a few B-lines are usually visible, but the number increases in all conditions involving enlarged interlobular septa, such as acute pulmonary edema, acute respiratory distress syndrome, pulmonary contusion, infectious pneumonia and aspiration pneumonia [43][44][45]. B-lines are, therefore, not specific findings of particular diseases; they are often associated with other suggestive US patterns [46] involving also pleural artifacts and must be correlated to clinical signs and symptoms.…”

Section: Pulmonary Contusionmentioning

confidence: 99%

“…In pulmonary contusion, the lesions are typically located at the impact site and characterized by lung sliding associated with interstitial syndrome and/or subpleural hypoechoic areas with irregular or ill-defined margins without air bronchogram (consolidation) [41,42]. As the B-lines originate from the parenchymal surface of the lung, their presence in the field of view of the probe suggests juxtaposition of the two pleural layers thereby excluding pneumothorax with a NPV close to 100 % [44].…”

Section: Pulmonary Contusionmentioning

confidence: 99%

Bedside US imaging in multiple trauma patients. Part 1: US findings and techniques

Sofia

2013

J Ultrasound

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Objectives The aim of this review article is to present the current views and visions of the role of ultrasound (US) in the management of patients with multiple trauma. The article is divided into two parts. Part 1 (US findings and techniques) will mainly deal with the technical aspects of US imaging in trauma patients and is written also for educational purposes. Part 2 (pathophysiology and US imaging in trauma patients) will deal with integration of US in the clinical and pathophysiological management of multiple trauma patients. Methods A non-systematic review of the literature through PubMed search (restricted to the last 10 years) of original articles and review articles. Results 80 publications were selected for Part 1. Of these 80 articles, the author selected 50 according to personal criteria on the basis of their innovative or original contents (48 original articles and 2 literature review articles); 19 articles were furthermore extracted from the references of the selected publications. The information extracted from these 69 publications was organized into sections dealing with different fields of applications of US imaging in multiple trauma patients. Conclusions US imaging in trauma has evolved from the initial use, i.e., early diagnosis of peritoneal effusion (focused abdominal sonography for trauma), to a wider use known as resuscitative ultrasonography, and is today considered as an extension of physical examination to implement a more effective approach to clinical problems and increase the timeliness and safety of interventions. Keywords Trauma Á Ultrasound Á Ultrasound findings Á Ultrasound techniqueRiassunto Obiettivi L'obiettivo di questa ricerca è di presentare la visione e le opinioni correnti sul ruolo dell'ecografia nella gestione del paziente con politrauma. L'articolo è diviso in due parti: nella prima ('Semeiotica ecografica e tecnica di esecuzione dell'esame') verrà data attenzione agli aspetti prevalentemente tecnici dell'ecografia nel trauma, con intento anche didattico; nella seconda (Fisiopatologia e ecografia clinica del trauma) sarà esplorato il tema dell'integrazione dell'ecografia con la clinica e la fisiopatologia nella gestione del politraumatizzato. Metodi Revisione non sistematica della letteratura. Ricerca su PubMed (restrizione agli ultimi 10 anni) di articoli originali e revisioni. Risultati Per la Parte prima sono stati selezionati 80 articoli, tra i quali sono stati scelti con criteri personali quelli ritenuti innovativi o originali nei contenuti (48 articoli originali, 2 revisioni di letteratura). 19 articoli sono stati estratti dalla bibliografia delle pubblicazioni prescelte. I contenuti estratti dai 69 articoli sono stati organizzati in paragrafi intitolati ai singoli ambiti di applicazione dell'ecografia nel politrauma. Conclusioni L'ecografia del trauma è evoluta dalla iniziale applicazione nella diagnosi precoce del versamento peritoneale (Focused Abdominal Sonography for Trauma o FAST) all'accezione più ampia di Resuscitative Ultrasonography (RUS) e v...

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Acute heart failure: new diagnostic perspectives for the emergency physician

Cited by 14 publications

References 40 publications

Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the Emergency Department

Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the Emergency Department

Acute Heart Failure Syndromes: Emergency Department Presentation, Treatment, and Disposition: Current Approaches and Future Aims

Bedside US imaging in multiple trauma patients. Part 1: US findings and techniques

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