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Chest. 2019 Aug 2. pii: S0012-3692(19)31393-5. doi: 10.1016/j.chest.2019.07.017. [Epub ahead of print]

Accuracy of Several Lung Ultrasound Methods for the Diagnosis of Acute Heart Failure in the ED: A Multicenter Prospective Study.

Author information

1
Emergency Department, University Hospital of Nancy, France.
2
Emergency Department, University Hospital of Nancy, France; Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy France Groupe choc, INSERM U1116, Faculté de Médecine, 54500 Vandoeuvre les Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France. Electronic address: t.chouihed@gmail.com.
3
Université de Lorraine, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandœuvre-lès-Nancy, France, Centre National de la Recherche Scientifique, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandœuvre-lès-Nancy, France, INRIA, Project-Team BIGS, Villers-lès-Nancy, France; Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy France Groupe choc, INSERM U1116, Faculté de Médecine, 54500 Vandoeuvre les Nancy, France.
4
Emergency Department, Colmar Hospital, Colmar, France.
5
Emergency Department, Charleville-Maizières Hospital, Charleville-Maizières France.
6
Emergency Department, Mercy Hospital, Metz, France.
7
Intensive Care Unit, University Hospital of Nancy, France.
8
Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
9
University of Perugia, School of Medicine, Perugia, Division of Cardiology.
10
Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy France Groupe choc, INSERM U1116, Faculté de Médecine, 54500 Vandoeuvre les Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
11
Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre les Nancy France Groupe choc, INSERM U1116, Faculté de Médecine, 54500 Vandoeuvre les Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France; Département de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU Nancy, France.

Abstract

BACKGROUND:

Early appropriate diagnosis of acute heart failure (AHF) is recommended by international guidelines. This study assessed the value of several lung ultrasound (LUS) strategies for identifying AHF in the ED.

METHODS:

This prospective study, conducted in four EDs, included patients with diagnostic uncertainty based on initial clinical judgment. A clinical diagnosis score for AHF (Brest score) was quantified, followed by an extensive LUS examination performed according to the 4-point (BLUE protocol) and 6-, 8-, and 28-point methods. The primary outcome was AHF discharge diagnosis adjudicated by two senior physicians blinded to LUS measurements. The C-index was used to quantify discrimination.

RESULTS:

Among the 117 included patients, AHF (n = 69) was identified in 27.4%, 56.2%, 54.8%, and 76.7% of patients with the 4-point (two bilateral positive points), 6-point, 8-point (≥ 1 bilateral positive point), and 28-point (B-line count ≥ 30) methods, respectively. The C-index (95% CI) of the Brest score was 72.8 (65.3-80.3), whereas the C-index of the 4-, 6-, 8-, and 28-point methods were 63.7 (58.5-68.8), 72.4 (65.0-79.8), 74.0 (67.1-80.9), and 72.4 (63.9-80.9). The highest increase in the C-index on top of the BREST score was observed with the 8-point method in the whole population (6.9; 95% CI, 1.6-12.2; P = .010) and in the population with an intermediate Brest score, followed by the 6-point method.

CONCLUSIONS:

In patients with diagnostic uncertainty, the 6-point/8-point LUS method (using the 1 bilateral positive point threshold) improves AHF diagnosis accuracy on top of the BREST score.

TRIAL REGISTRY:

ClinicalTrials.gov; No.: NCT03194243; URL: www.clinicaltrials.gov.

KEYWORDS:

acute heart failure; dyspnea; emergency; lung ultrasound

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