Laura Conangla1, Mar Domingo1, Josep LupÓn2, AsunciÓn Wilke3, Gladys JuncÀ4, Xavier Tejedor5, Giovanni Volpicelli6, Lidia Evangelista7, Guillem Pera8, Pere Toran8, Ariadna Mas9, GermÁn Cediel4, JosÉ MarÍa VerdÚ10, Antoni Bayes-Genis11. 1. (1)Primary Care service Barcelonès Nord i Maresme, Badalona, Catalan Health Institute, Spain;; Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain. 2. Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain;; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. 3. (1)Primary Care service Barcelonès Nord i Maresme, Badalona, Catalan Health Institute, Spain;; Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 4. Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. 5. Biochemistry Service, University Hospital Germans Trias i Pujol, Badalona, Spain. 6. Emergency Department, University Hospital San Luigi Gonzaga, Torino, Italy; and. 7. Primary Care service Barcelona. Catalan Health Institute, Spain. 8. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain. 9. (1)Primary Care service Barcelonès Nord i Maresme, Badalona, Catalan Health Institute, Spain;; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 10. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain;; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain;; Primary Care service Barcelona. Catalan Health Institute, Spain. 11. Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain;; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain;. Electronic address: abayesgenis@gmail.com.
Abstract
BACKGROUND: Lung ultrasound (LUS) is useful for diagnosing pulmonary congestion, but its value in primary care remains unclear. We investigated whether LUS improved diagnostic accuracy in outpatients with heart failure (HF) suspicion. METHODS AND RESULTS: LUS was performed on 2 anterior (A), 2 lateral (L), and 2 posterior (P) areas per hemithorax. An area was positive when ≥3 B-lines were observed. Two diagnostic criteria were used: for LUS-C1, 2 positive areas of 4 (A-L) on each hemithorax; and for LUS-C2, 2 positive areas of 6 (A-L-P) on each hemithorax. A cardiologist blinded to LUS validated HF diagnosis. 162 patients were included (age 75.6 ± 9.4 years, 70.4% women). Both LUS criteria, alone and combined with other HF diagnostic criteria, were accurate for identifying HF. LUS-C2 outperformed LUS-C1, showing remarkable specificity (0.99) and positive predictive value (0.92). LUS-C2, together with Framingham criteria, N-terminal pro-B-type natriuretic peptide, and electrocardiogram, added diagnostic value (area under the receiver operating characteristic curves 0.90 with LUS-C2 vs 0.84 without; P = .006). In the absence of N-terminal pro-B-type natriuretic peptide, LUS-C2 significantly reclassified one-third of patients above Framingham criteria and electrocardiogram (net reclassification improvement 0.65, 95% confidence interval 0.04-1.1). CONCLUSIONS: LUS was accurate enough to rule-in HF in a primary care setting. The accuracy of diagnostic workup for HF in primary care is enhanced by incorporating LUS, irrespective NT-proBNP availability.
BACKGROUND: Lung ultrasound (LUS) is useful for diagnosing pulmonary congestion, but its value in primary care remains unclear. We investigated whether LUS improved diagnostic accuracy in outpatients with heart failure (HF) suspicion. METHODS AND RESULTS: LUS was performed on 2 anterior (A), 2 lateral (L), and 2 posterior (P) areas per hemithorax. An area was positive when ≥3 B-lines were observed. Two diagnostic criteria were used: for LUS-C1, 2 positive areas of 4 (A-L) on each hemithorax; and for LUS-C2, 2 positive areas of 6 (A-L-P) on each hemithorax. A cardiologist blinded to LUS validated HF diagnosis. 162 patients were included (age 75.6 ± 9.4 years, 70.4% women). Both LUS criteria, alone and combined with other HF diagnostic criteria, were accurate for identifying HF. LUS-C2 outperformed LUS-C1, showing remarkable specificity (0.99) and positive predictive value (0.92). LUS-C2, together with Framingham criteria, N-terminal pro-B-type natriuretic peptide, and electrocardiogram, added diagnostic value (area under the receiver operating characteristic curves 0.90 with LUS-C2 vs 0.84 without; P = .006). In the absence of N-terminal pro-B-type natriuretic peptide, LUS-C2 significantly reclassified one-third of patients above Framingham criteria and electrocardiogram (net reclassification improvement 0.65, 95% confidence interval 0.04-1.1). CONCLUSIONS: LUS was accurate enough to rule-in HF in a primary care setting. The accuracy of diagnostic workup for HF in primary care is enhanced by incorporating LUS, irrespective NT-proBNP availability.
Authors: Mar Domingo; Josep Lupón; Nicolas Girerd; Laura Conangla; Marta de Antonio; Pedro Moliner; Evelyn Santiago-Vacas; Pau Codina; German Cediel; Giosafat Spitaleri; Beatriz González; Violeta Diaz; Carmen Rivas; Patricia Velayos; Julio Núñez; Antoni Bayes-Genís Journal: ESC Heart Fail Date: 2021-11-01