Emanuele Pivetta1,2, Alberto Goffi3,4,5, Peiman Nazerian6, Davide Castagno7, Camilla Tozzetti8, Pietro Tizzani2,9, Maria Tizzani2, Giulio Porrino2, Enrico Ferreri2, Valeria Busso2, Fulvio Morello2, Cristina Paglieri2, Monica Masoero10, Elisa Cassine11, Federica Bovaro10, Stefano Grifoni6, Milena M Maule1, Enrico Lupia2,12. 1. Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Italy. 2. Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy. 3. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. 4. Department of Medicine, Division of Respirology (Critical Care), University Health Network, Toronto, Canada. 5. Department of Medicine, University of Toronto, Toronto, Canada. 6. Department of Emergency Medicine, Careggi University Hospital, Florence, Italy. 7. Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy. 8. Division of Internal Medicine, Department of Emergency Medicine, Careggi University Hospital, Florence, Italy. 9. Residency Program in Internal Medicine, University of Turin, Turin, Italy. 10. Residency Program in Emergency Medicine, University of Turin, Turin, Italy. 11. School of Medicine, University of Turin, Turin, Italy. 12. Department of Medical Sciences, University of Turin, Turin, Italy.
Abstract
AIMS: Although acute decompensated heart failure (ADHF) is a common cause of dyspnoea, its diagnosis still represents a challenge. Lung ultrasound (LUS) is an emerging point-of-care diagnostic tool, but its diagnostic performance for ADHF has not been evaluated in randomized studies. We evaluated, in patients with acute dyspnoea, accuracy and clinical usefulness of combining LUS with clinical assessment compared to the use of chest radiography (CXR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in conjunction with clinical evaluation. METHODS AND RESULTS: This was a randomized trial conducted in two emergency departments. After initial clinical evaluation, patients with acute dyspnoea were classified by the treating physician according to presumptive aetiology (ADHF or non-ADHF). Patients were subsequently randomized to continue with either LUS or CXR/NT-proBNP. A new diagnosis, integrating the results of both initial assessment and the newly obtained findings, was then recorded. Diagnostic accuracy and clinical usefulness of LUS and CXR/NT-proBNP approaches were calculated. A total of 518 patients were randomized. Addition of LUS had higher accuracy [area under the receiver operating characteristic curve (AUC) 0.95] than clinical evaluation alone (AUC 0.88) in identifying ADHF (P < 0.01). In contrast, use of CXR/NT-proBNP did not significantly increase the accuracy of clinical evaluation alone (AUC 0.87 and 0.85, respectively; P > 0.05). The diagnostic accuracy of the LUS-integrated approach was higher then that of the CXR/Nt-proBNP-integrated approach (AUC 0.95 vs. 0.87, p < 0.01). Combining LUS with the clinical evaluation reduced diagnostic errors by 7.98 cases/100 patients, as compared to 2.42 cases/100 patients in the CXR/Nt-proBNP group. CONCLUSION: Integration of LUS with clinical assessment for the diagnosis of ADHF in the emergency department seems to be more accurate than the current diagnostic approach based on CXR and NT-proBNP.
RCT Entities:
AIMS: Although acute decompensated heart failure (ADHF) is a common cause of dyspnoea, its diagnosis still represents a challenge. Lung ultrasound (LUS) is an emerging point-of-care diagnostic tool, but its diagnostic performance for ADHF has not been evaluated in randomized studies. We evaluated, in patients with acute dyspnoea, accuracy and clinical usefulness of combining LUS with clinical assessment compared to the use of chest radiography (CXR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in conjunction with clinical evaluation. METHODS AND RESULTS: This was a randomized trial conducted in two emergency departments. After initial clinical evaluation, patients with acute dyspnoea were classified by the treating physician according to presumptive aetiology (ADHF or non-ADHF). Patients were subsequently randomized to continue with either LUS or CXR/NT-proBNP. A new diagnosis, integrating the results of both initial assessment and the newly obtained findings, was then recorded. Diagnostic accuracy and clinical usefulness of LUS and CXR/NT-proBNP approaches were calculated. A total of 518 patients were randomized. Addition of LUS had higher accuracy [area under the receiver operating characteristic curve (AUC) 0.95] than clinical evaluation alone (AUC 0.88) in identifying ADHF (P < 0.01). In contrast, use of CXR/NT-proBNP did not significantly increase the accuracy of clinical evaluation alone (AUC 0.87 and 0.85, respectively; P > 0.05). The diagnostic accuracy of the LUS-integrated approach was higher then that of the CXR/Nt-proBNP-integrated approach (AUC 0.95 vs. 0.87, p < 0.01). Combining LUS with the clinical evaluation reduced diagnostic errors by 7.98 cases/100 patients, as compared to 2.42 cases/100 patients in the CXR/Nt-proBNP group. CONCLUSION: Integration of LUS with clinical assessment for the diagnosis of ADHF in the emergency department seems to be more accurate than the current diagnostic approach based on CXR and NT-proBNP.
Authors: P H Mayo; R Copetti; D Feller-Kopman; G Mathis; E Maury; S Mongodi; F Mojoli; G Volpicelli; M Zanobetti Journal: Intensive Care Med Date: 2019-08-15 Impact factor: 17.440
Authors: Elke Platz; Pardeep S Jhund; Nicolas Girerd; Emanuele Pivetta; John J V McMurray; W Frank Peacock; Josep Masip; Francisco Javier Martin-Sanchez; Òscar Miró; Susanna Price; Louise Cullen; Alan S Maisel; Christiaan Vrints; Martin R Cowie; Salvatore DiSomma; Hector Bueno; Alexandre Mebazaa; Danielle M Gualandro; Mucio Tavares; Marco Metra; Andrew J S Coats; Frank Ruschitzka; Petar M Seferovic; Christian Mueller Journal: Eur J Heart Fail Date: 2019-06-19 Impact factor: 15.534
Authors: Pierpaolo Pellicori; Elke Platz; Jeroen Dauw; Jozine M Ter Maaten; Pieter Martens; Emanuele Pivetta; John G F Cleland; John J V McMurray; Wilfried Mullens; Scott D Solomon; Faiez Zannad; Luna Gargani; Nicolas Girerd Journal: Eur J Heart Fail Date: 2020-11-23 Impact factor: 15.534
Authors: Øyvind Johannessen; Brian Claggett; Eldrin F Lewis; John D Groarke; Varsha Swamy; Moritz Lindner; Scott D Solomon; Elke Platz Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-10-27