Role of Point‐of‐Care Lung and Inferior Vena Cava Ultrasound in Clinical Decisions for Patients Presenting to the Emergency Department With Symptoms of Acute Decompensated Heart Failure

Abstract

Objectives This prospective study was performed to evaluate the diagnostic role of point‐of‐care lung ultrasound (LUS) and inferior vena cava (IVC) ultrasound in patients with acute decompensated heart failure (ADHF). Methods A prospective cohort study was conducted between January 2018 and November 2018 on patients with a diagnosis of ADHF in the emergency department (ED). On admission, LUS findings, inspiratory and expiratory IVC diameters, and the inferior vena cava collapsibility index (IVCCI) were obtained. After therapeutic interventions, third‐hour changes in LUS and the IVC index and the treatment response were assessed. Results Eighty patients were enrolled. Forty‐six (58%) patients had an ejection fraction (EF) greater than 40%, and 34 (42%) had an EF of less than 40%. Significant differences were detected between the admission and third‐hour inspiratory IVC diameter, expiratory IVC diameter, and IVCCI (P = .001). There was no correlation between the EF and inspiratory IVC diameter (r = −0.03; P = .976), expiratory IVC diameter (r = −109; P = .336), or IVCCI (r = −0.72; P = .523) and between the B‐type natriuretic peptide level and inspiratory IVC diameter (r = −0.58; P = .610), expiratory IVC diameter (r = −0.33; P = .774), or IVCCI (r = −0.78; P = .493) either. A comparison of admission and third‐hour numbers of B‐lines on LUS imaging showed a significant decrease in the number of B‐lines in all zones at the end of 3 hours (P = .001). A significant difference existed between the hospitalized and discharged patients with respect to IVC diameters and number of B‐lines. Conclusions In the ED setting, an assessment of B‐lines and measurement of IVC diameters are better markers than the B‐type natriuretic peptide level, EF, or chest x‐ray for diagnosis of ADHF and can be used to make decisions for hospitalization or discharge from the ED.

Point of Care Ultrasound for Diagnosis and Management in Heart Failure: A Targeted Literature Review

“…These reference variables included clinical assessment of volume status change (based on the resolution of peripheral edema) following administration or adjustment of diuretic dose as well as comparison to volume status determined from physical examination and reference echocardiography measurements. While most studies assessed the correlation between POCUS and the reference variables, Tchernodrinski et al and Hacıalioğulları et al assessed the change in IVC diameter relative to baseline at various time points following diuretic administration 14 , 15 .The reliability of POCUS as a tool compared to other methods of assessing volume status was tested by Nixon et al and Dalen et al Nixon et al found a significant correlation between physical volume assessment and POCUS IVC d measurements 13 , and Dalen et al found a significant correlation between POCUS and baseline echocardiography measurements of IVC max , IVC min , and determination of PE 16 .…”

The diagnostic capabilities of the combined cardiac and lung point of care ultrasound in shocked patients at the emergency department – Resourced limited country

“…Another study [31] demonstrated cardiac ultrasound may identify an unanticipated critical finding in sepsis patient. Moreover, B-line artifacts finding appeared to represent the left ventricular function and volume status of the patient [32] , [33] . However, the accuracy of POCUS diagnosed in distributive shocked patient was only 69.61 % which the agreement of with the final hospital diagnosis was fair.…”

Assessment of Volume Status in Hospitalized Patients With Chronic Heart Failure

“…A number of small, randomized trials have evaluated the utility of POCUS as a tool for improving efficiency and accuracy of diagnosis of a variety of intrathoracic conditions including respiratory failure and cardiopulmonary congestion from HF, the results of which have been in favor of its use [60][61][62][63]. There is some evidence to suggest that demonstration of pulmonary B-lines on POCUS and measurement of inferior vena cava (IVC) diameters may outperform traditional objective measures of volume assessment including NT-ProBNP level and CXR findings [64,65]. Expert opinion currently supports the use of POCUS as an augmentation to comprehensive volume status examination, which has been supported by consensus statements and recommendations by the American Society of Echocardiography and the American College of Physicians [66,67].…”