Aurélien Buessler1, Tahar Chouihed2, Kévin Duarte3, Adrien Bassand1, Matthieu Huot-Marchand1, Yannick Gottwalles4, Alice Pénine5, Elies André6, Lionel Nace7, Déborah Jaeger1, Masatake Kobayashi8, Stefano Coiro9, Patrick Rossignol10, Nicolas Girerd11. 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, Centre National de la Recherche Scientifique, 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.
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.
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: Masatake Kobayashi; Luna Gargani; Alberto Palazzuoli; Giuseppe Ambrosio; Antoni Bayés-Genis; Josep Lupon; Pierpaolo Pellicori; Nicola Riccardo Pugliese; Yogesh N V Reddy; Gaetano Ruocco; Kevin Duarte; Olivier Huttin; Patrick Rossignol; Stefano Coiro; Nicolas Girerd Journal: Clin Res Cardiol Date: 2020-08-08 Impact factor: 5.460