THE DIAGNOSTIC VALUE OF LUNG ULTRASONOGRAPHY IN DIAGNOSINGACUTE HEART FAILURE IN EMERGENCY DEPARTMENT

Abstract

Introduction: Acute Heart Failure (AHF) is one of the main causes of acute dyspnea that is encountered in the Emergency Department (ED). A misdiagnosis or late diagnosis of AHF can lead to longer treatment days, higher mortality and increased costs. Pulmonary congestion is a universal finding in AHF. The number of Blines on pulmonary ultrasonography correlates strongly with extravascular pulmonary fluid. The aim of this study was to evaluate the diagnostic value of pulmonary ultrasonography in differentiating AHF from other causes of acute dyspnea in the ED.

Method: This was a cross-sectional study conducted at H. Adam Malik General Hospital from January to July 2019. History taking, physical examination, chest X-ray and laboratory examination were performed on all acute dyspnea patients who came to the emergency room. Lung ultrasonography was then performed on four areas of each hemithorax. Bilateral discovery of two positive zones (> 2 B-lines) is considered AHF. After the patient returns home or dies, two cardiologists who are not aware of the results of lung ultrasonography will review the patient's medical record and then determine the patient's final diagnosis (diagnosis of gold standard). The diagnosis criteria for AHF refer to the 2016 European Society of Cardiology (ESC) heart failure guidelines and the patient's response to therapy. If there is a discrepancy, then third cardiologist is asked for his opinion.

Results: This study included 121 patients with a median age of 59 (52-64) and most were male (84.3%). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of lung ultrasonographic examinations were 93%, 88%, 88%, 93%, 7.75 and 0.07, respectively. AUC of lung ultrasonography is 0.90. Addition of clinical and laboratory data can increase the AUC to 0.96. The B-line number correlated strongly with NT-pro BNP (r = 0.80, p <0.001).

Conclusion: Lung ultrasonography is an easy examination and has a very good diagnostic accuracy. Integration with clinical examination can improve diagnosis accuracy.