Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study
Emanuele Pivetta, Alberto Goffi, Enrico Lupia, Maria Tizzani, Giulio Porrino, Enrico Ferreri, Giovanni Volpicelli, Paolo Balzaretti, Alessandra Banderali, Antonello Iacobucci, Stefania Locatelli, Giovanna Casoli, Michael B Stone, Milena M Maule, Ileana Baldi, Franco Merletti, Gian Alfonso Cibinel, Paolo Baron, Stefania Battista, Giuseppina Buonafede, Valeria Busso, Andrea Conterno, Paola Del Rizzo, Patrizia Ferrera, Paolo Fascio Pecetto, Corrado Moiraghi, Fulvio Morello, Fabio Steri, Giovannino Ciccone, Cosimo Calasso, Mimma A Caserta, Marina Civita, Carmen Condo', Vittorio D'Alessandro, Sara Del Colle, Stefania Ferrero, Giulietta Griot, Emanuela Laurita, Alberto Lazzero, Francesca Lo Curto, Marianna Michelazzo, Vincenza Nicosia, Nicola Palmari, Alberto Ricchiardi, Andrea Rolfo, Roberto Rostagno, Fabrizio Bar, Enrico Boero, Mauro Frascisco, Ilaria Micossi, Alessandro Mussa, Valerio Stefanone, Renzo Agricola, Gabriele Cordero, Federica Corradi, Cristina Runzo, Aldo Soragna, Daniela Sciullo, Domenico Vercillo, Attilio Allione, Nicoletta Artana, Fabrizio Corsini, Luca Dutto, Giuseppe Lauria, Teresa Morgillo, Bruno Tartaglino, Daniela Bergandi, Ilaria Cassetta, Clotilde Masera, Mario Garrone, Gianluca Ghiselli, Livia Ausiello, Letizia Barutta, Emanuele Bernardi, Alessia Bono, Daniela Forno, Alessandro Lamorte, Davide Lison, Bartolomeo Lorenzati, Elena Maggio, Ilaria Masi, Matteo Maggiorotto, Giulia Novelli, Francesco Panero, Massimo Perotto, Marco Ravazzoli, Elisa Saglio, Flavia Soardo, Alessandra Tizzani, Pietro Tizzani, Mattia Tullio, Marco Ulla, Elisa Romagnoli, SIMEU Group for Lung Ultrasound in the Emergency Department in Piedmont, Emanuele Pivetta, Alberto Goffi, Enrico Lupia, Maria Tizzani, Giulio Porrino, Enrico Ferreri, Giovanni Volpicelli, Paolo Balzaretti, Alessandra Banderali, Antonello Iacobucci, Stefania Locatelli, Giovanna Casoli, Michael B Stone, Milena M Maule, Ileana Baldi, Franco Merletti, Gian Alfonso Cibinel, Paolo Baron, Stefania Battista, Giuseppina Buonafede, Valeria Busso, Andrea Conterno, Paola Del Rizzo, Patrizia Ferrera, Paolo Fascio Pecetto, Corrado Moiraghi, Fulvio Morello, Fabio Steri, Giovannino Ciccone, Cosimo Calasso, Mimma A Caserta, Marina Civita, Carmen Condo', Vittorio D'Alessandro, Sara Del Colle, Stefania Ferrero, Giulietta Griot, Emanuela Laurita, Alberto Lazzero, Francesca Lo Curto, Marianna Michelazzo, Vincenza Nicosia, Nicola Palmari, Alberto Ricchiardi, Andrea Rolfo, Roberto Rostagno, Fabrizio Bar, Enrico Boero, Mauro Frascisco, Ilaria Micossi, Alessandro Mussa, Valerio Stefanone, Renzo Agricola, Gabriele Cordero, Federica Corradi, Cristina Runzo, Aldo Soragna, Daniela Sciullo, Domenico Vercillo, Attilio Allione, Nicoletta Artana, Fabrizio Corsini, Luca Dutto, Giuseppe Lauria, Teresa Morgillo, Bruno Tartaglino, Daniela Bergandi, Ilaria Cassetta, Clotilde Masera, Mario Garrone, Gianluca Ghiselli, Livia Ausiello, Letizia Barutta, Emanuele Bernardi, Alessia Bono, Daniela Forno, Alessandro Lamorte, Davide Lison, Bartolomeo Lorenzati, Elena Maggio, Ilaria Masi, Matteo Maggiorotto, Giulia Novelli, Francesco Panero, Massimo Perotto, Marco Ravazzoli, Elisa Saglio, Flavia Soardo, Alessandra Tizzani, Pietro Tizzani, Mattia Tullio, Marco Ulla, Elisa Romagnoli, SIMEU Group for Lung Ultrasound in the Emergency Department in Piedmont
Abstract
Background: Lung ultrasonography (LUS) has emerged as a noninvasive tool for the differential diagnosis of pulmonary diseases. However, its use for the diagnosis of acute decompensated heart failure (ADHF) still raises some concerns. We tested the hypothesis that an integrated approach implementing LUS with clinical assessment would have higher diagnostic accuracy than a standard workup in differentiating ADHF from noncardiogenic dyspnea in the ED.
Methods: We conducted a multicenter, prospective cohort study in seven Italian EDs. For patients presenting with acute dyspnea, the emergency physician was asked to categorize the diagnosis as ADHF or noncardiogenic dyspnea after (1) the initial clinical assessment and (2) after performing LUS ("LUS-implemented" diagnosis). All patients also underwent chest radiography. After discharge, the cause of each patient's dyspnea was determined by independent review of the entire medical record. The diagnostic accuracy of the different approaches was then compared.
Results: The study enrolled 1,005 patients. The LUS-implemented approach had a significantly higher accuracy (sensitivity, 97% [95% CI, 95%-98.3%]; specificity, 97.4% [95% CI, 95.7%-98.6%]) in differentiating ADHF from noncardiac causes of acute dyspnea than the initial clinical workup (sensitivity, 85.3% [95% CI, 81.8%-88.4%]; specificity, 90% [95% CI, 87.2%-92.4%]), chest radiography alone (sensitivity, 69.5% [95% CI, 65.1%-73.7%]; specificity, 82.1% [95% CI, 78.6%-85.2%]), and natriuretic peptides (sensitivity, 85% [95% CI, 80.3%-89%]; specificity, 61.7% [95% CI, 54.6%-68.3%]; n = 486). Net reclassification index of the LUS-implemented approach compared with standard workup was 19.1%.
Conclusions: The implementation of LUS with the clinical evaluation may improve accuracy of ADHF diagnosis in patients presenting to the ED.
Trial registry: Clinicaltrials.gov; No.: NCT01287429; URL: www.clinicaltrials.gov.
Source: PubMed