Point-of-care chest ultrasound for diagnosing acute heart failure in emergency department patients with acute dyspnea: diagnostic performance of an ultrasound-based algorithm integrating DTE
Resumen
Introduction: Acute heart failure (AHF) is a common etiology of acute dyspnea in the emergency department. We studied the diagnostic performance of an ultrasound algorithm integrating DTE to establish the diagnosis of AHF in patients coming to the emergency department with acute dyspnea.
Methods: Prospective analysis of a convenience sample of patients with acute dyspnea in emergency department. The ultrasound algorithm included lung ultrasound findings and 4 echocardiographic measurements: mitral annular plane systolic exclusion, Doppler mitral flow velocity, tissue Doppler imaging of the lateral mitral annulus and early mitral flow deceleration time (DTE). The definitive diagnosis was made by 2 physicians blinded to the ultrasound findings.
Results: A total of 166 adult patients with a mean age (SD) of 76 (13) years were included; 48% (n=79) were women. Sixty-two patients (37%) were finally diagnosed with AHF. Interindividual agreement on the physicians’ diagnoses was good (κ = 0,71). The diagnostic performance indicators for the ultrasound algorithm integrating DTE were as follows : area under the receiver operating characteristic curve 0.91(95% CI, 0.86-0.96) ; sensitivity 87% (95% CI, 76%-94%) ; specificity 95% (95% CI, 89%-98%) ; positive likelihood ratio 18.1 (95% CI, 7.7-42.8) ; negative likelihood ration 0.14 (95% CI, 0.07-0.26). There were no unclassified patients.
Conclusion: The ultrasound algorithm integrating DTE for diagnosing AHF performed well in patients coming to the emergency department with acute dyspnea. In addition, it allows classification of all patients, contrary to the previous algorithm without DTE.
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