scholarly journals LO074: Point of care ultrasound for lung B-lines in the early diagnosis of acute decompensated heart failure in the emergency department: a systematic review

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S55-S55
Author(s):  
K. McGivery ◽  
P.R. Atkinson ◽  
D. Lewis ◽  
L. Taylor ◽  
K. Gadd
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Emergency Department ◽  
Likelihood Ratio ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Point Of Care Ultrasound ◽  
B Lines

Introduction: Dyspnea is a common presenting problem in the emergency department (ED) that frequently creates a diagnostic challenge for physicians. Acute decompensated heart failure (ADHF) represents a common cause that requires prompt diagnosis and management. Recent studies on dyspneic patients have suggested a potential role for point-of-care ultrasound (PoCUS). The objective of this systematic review was to assess the sensitivity and specificity of early bedside lung ultrasound in patients presenting to the ED with dyspnea. Methods: A search of the literature was conducted using PubMed, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conferences. We included prospective studies that assessed the diagnostic accuracy of B-lines from bedside lung ultrasound in the ED patients compared to a clinical diagnosis of ADHF at hospital discharge. The final diagnosis included at least one of CXR, computed tomography, or BNP. Two reviewers independently screened all titles and abstracts for possible inclusions. Two separate content experts full text-reviewed selected studies and performed quality analysis using a modified Critical Appraisal Skills Program (CASP) questionnaire. Extracted data was assessed with summary receiver operator characteristics curve (SROC) analysis with pooled sensitivity and specificity. Heterogenity was tested. Results: The electronic search yielded 3674 articles of which six met the inclusion criteria and fulfilled CASP requirements for methodological quality. The total number of patients in these studies was 1911. Heterogeneity was noted; due to poorer performance by novice users. Meta-analysis of the data showed that in detecting ADHF, bedside lung ultrasound had a pooled sensitivity of 89.6% (95% CI 69.5 to 97.0%) and a pooled specificity of 88.4% (95% CI 75.0 to 95.1%). The positive likelihood ratio was 6.01 (95% CI 2.93 to 12.32) and negative likelihood ratio was 0.13 (95% CI 0.06 to 0.30). Conclusion: This study suggests that in patients presenting to the ED with undifferentiated dyspnea, early point of care lung ultrasound may be used to confirm the diagnosis of ADHF, which may facilitate earlier appropriate management. Test performance may vary according to experience.

scholarly journals Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: a systematic review and meta-analysis

CJEM ◽  
2018 ◽  
Vol 20 (3) ◽  
pp. 343-352 ◽  
Author(s):  
Kyle McGivery ◽  
Paul Atkinson ◽  
David Lewis ◽  
Luke Taylor ◽  
Tim Harris ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Emergency Department ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Meta Analysis ◽  
Decompensated Heart Failure ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
B Lines

AbstractObjectivesDyspnea is a common presenting problem that creates a diagnostic challenge for physicians in the emergency department (ED). While the differential diagnosis is broad, acute decompensated heart failure (ADHF) is a frequent cause that can be challenging to differentiate from other etiologies. Recent studies have suggested a potential diagnostic role for emergency lung ultrasound (US). The objective of this systematic review was to assess the accuracy of early bedside lung US in patients presenting to the ED with dyspnea.MethodsA systematic search of EMBASE, PubMed, and the Cochrane Library was performed in addition to a grey literature search. We selected prospective studies that reported on the sensitivity and specificity of B-lines from early lung ultrasound in dyspneic patients presenting to the ED. Selected studies underwent quality assessment using the Critical Appraisal and Skills Program (CASP) questionnaire.Data Extraction and SynthesisThe search yielded 3674 articles; seven studies met inclusion criteria and fulfilled CASP requirements for a total of 1861 patients. Summary statistics from the meta-analysis showed that as a diagnostic test for ADHF, bedside lung US had a pooled sensitivity of 82.5% (95% confidence interval [CI]=66.4% to 91.8%) and a pooled specificity of 83.6% (95% CI=72.4% to 90.8%).ConclusionsOur results suggest that in patients presenting to the ED with undifferentiated dyspnea, B-lines from early bedside lung US may be reliably used as an adjunct to current diagnostic methods. The incorporation of lung US may lead to more appropriate and timely diagnosis of patients with undifferentiated ADHF.

scholarly journals P305 The evaluation of left ventricle filling pressure and lung ultrasound B-lines in the diagnosis of cardiogenic dyspnea

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Valova
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Filling Pressure ◽  
Diagnostic Methods ◽  
Grey Zone ◽  
X Ray ◽  
B Lines

Abstract Introduction Dyspnea is the most frequent symptom of acute heart failure but it could also be a clinical presentation of some other noncardiogenic conditions. The differentiation of the origin of dyspnea could sometimes be a difficult task. The estimated elevation of left ventricle filling pressure with lung ultrasound proved positive B-lines score > 15 could be reliable as diagnostic methods for acute decompensated heart failure and proof of the cardiogenic origin of dyspnea. Purpose To evaluate the reliability of elevated left ventricle filling pressure and positive lung ultrasound B-lines score in differentiation of the origin of dyspnea. Methods Elevated E/e´>15 as a proof for elevated left ventricle filling pressure and multiple bilateral LUS B-lines (>15) were tested against conventional X-ray and NT-proBNP in 44 patients with cardiogenic dyspnea (23 NYHA III patients and 21 NYHA IV patients) and 42 patients with noncardiogenic dyspnea. Results Elevated left ventricle filling pressure detected with echocardography (E/e´>15) as a proof of acute decompensated heart failure was found in 18 NYHA IV patients and strongly correlated with multiple bilateral LUS B-lines > 15 (all 21 NYHA IV patients), alveolar edema from conventional X-ray (21 NYHA IV patients) and NTproBNP > 1000pg/ml in 17 NYHA IV patients. The results for NYHA III patients differ very much. Elevated filling pressure (E/e´ > 15) from echocardiography was found in 10 patients NYHA III. For the left 13 patients NYHA III E/e´ was in grey zone between 8-14. Multiple bilateral LUS B-lines >15 were found in 18 NYHA III patients. Interstitial pulmonary edema was found in 15 NYHA III patients and NTproBNP > 1000pg/ml was found in 16 NYHA III patients. E/e´ between 8-14 (grey zone) moderately correlated with NT-proBNP and strongly with pulmonary blood flow redistribution and interstitial edema from X-ray. Normal left ventricle filling pressure (E/e´ < 8) was found in 36 noncardiogenic patients. Only 6 patients with noncardiogenic dyspnea were with elevated left ventricle filling pressure (E/e´ > 15) which was explained with their overweight (BMI > 30) and hypervolemia and correlated with negative LUS B-lines. Only 1 patient with noncardiogenic dyspnea was with false positive B-lines score > 15 typical for pneumonia. Conclusions Elevated left ventricle filling pressure detected with Tissue Doppler echocardiography (E/e´>15) and positive LUS B-lines score > 15 are reliable modalities for the diagnosis of cardiogenic dyspnea in patients NYHA IV. In patient NYHA III with cardiogenic dyspnea the two presented modalities proved to be with moderate reliability and need references from conventional X-ray and NT-proBNP.

scholarly journals Hospitalist perspectives of available tests to monitor volume status in patients with heart failure: a qualitative study

2020 ◽  
Author(s):  
Anna M Maw ◽  
Carolina Ortiz-lopez ◽  
Megan A Morris ◽  
Christine Jones ◽  
Elaine Gee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Volume Status ◽  
Structured Interviews ◽  
Patients With Heart Failure ◽  
The Us ◽  
Time Required

AbstractAcute decompensated heart failure is the leading admitting diagnosis in patients 65 and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in 5 geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.

scholarly journals Point-of-Care Ultrasound Identifies Decompensated Heart Failure in a Young Male with Methamphetamine-Associated Cardiomyopathy Presenting in Severe Sepsis to the Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
David Kinas ◽  
Michael Dalley ◽  
Kayla Guidry ◽  
Mark A. Newberry ◽  
David A. Farcy
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Severe Sepsis ◽  
Point Of Care ◽  
Disease Process ◽  
Young Male ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Point Of Care Ultrasound ◽  
Methamphetamine Abuse

We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management. Emergency physicians can utilize point-of-care ultrasound (POCUS) to help identify these high-risk patients in the emergency department and guide appropriate resuscitation. Methamphetamine-Associated Cardiomyopathy (MAC) is an infrequently described complication of methamphetamine abuse, most commonly presented as a nonischemic dilated cardiomyopathy. With the rise in methamphetamine abuse in the United States, complications from methamphetamine use are more commonly presenting to the emergency department. Proper education and rehabilitation, with a goal of abstinence from amphetamine use, may allow patients to potentially regain normal cardiac function. Since the majority of patients present late with severe cardiac dysfunction, early detection is essential amongst critically ill patients since recognition may significantly influence ED management.

Abstract 346: A Trial of Pre-discharge Point of Care Ultrasound for Acute Decompensated Heart Failure

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Neal Olarte ◽  
Mark Jacobs ◽  
Louis Vincent ◽  
Jonathan Salter ◽  
Aileen Andreu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Clinical Decision Making ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Volume Status ◽  
Fiscal Year ◽  
Point Of Care Ultrasound ◽  
Increased Risk ◽  
B Lines

Background: Acute decompensated heart failure (ADHF) is a primary reason for hospital admission and readmission in the elderly. Prior studies have demonstrated that sonographic pulmonary B-lines and large inferior vena cava (IVC) diameter with reduced collapsibility may accurately predict ADHF readmission. Ultrasound is a readily available bedside tool that can be used to assess a patient’s volume status, which can be difficult to assess under certain clinical conditions. The purpose of this project is to determine if a pre-discharge focused lung and IVC ultrasound exam can be used to predict readmission in a veteran patient population. Methods: This is a single-center study conducted at the Miami Veterans Affair Medical Center (VAMC). Only patients with a primary diagnosis of ADHF admitted to a hospitalist team through the emergency room will be considered. Exclusion criteria include: pre-existing structural lung disease; primary right-sided heart failure; severe tricuspid regurgitation; or hospice status. A single operator will evaluate all included patients for B-lines and IVC dimension within 24 hours of admission and discharge. Ultrasound results, without management recommendations, will be given to hospitalists to use at their discretion to support clinical decision-making. Patients will be categorized based on positive or negative ultrasound findings. The primary outcome of interest is 30-day readmission rate. Secondary outcomes include 90-day readmission, all-cause mortality, length of stay, and changes in weight or renal function. Chi-square and Mann-Whitney testing will be used to analyze categorical and continuous variables, respectively. Kaplan-Meier survival curves will be generated for both patient cohorts. Results/Anticipated Results: Through quarter 3 of fiscal year 2019, the Miami VAMC had 215 unique admissions for ADHF. The average 30-day readmission rate per quarter was 18.44% (total 40 of 215). Study enrollment is ongoing. We anticipate that many patients may demonstrate discrepancy of volume status between their clinical and ultrasound exams, and that patients found to have B-lines and/or large IVCs with poor collapsibility will have worse outcomes. Conclusion: Decreasing readmissions for acute decompensated heart failure is a priority for both patients and physicians. Persistent volume overload has been associated with increased risk for readmission. Ultrasound may be a useful augmentation to the physical exam to determine a patient’s volume status to further guide inpatient treatment, predict prognosis, and determine readiness for discharge.

Point-of-care ultrasound diagnoses acute decompensated heart failure in the ED regardless of examination findings

2014 ◽  
Vol 32 (4) ◽  
pp. 385-388 ◽  
Author(s):  
Kenton L. Anderson ◽  
Katherine Y. Jenq ◽  
J. Matthew Fields ◽  
Nova L. Panebianco ◽  
Anthony J. Dean
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Point Of Care Ultrasound

Clinical Applicability of Lung Ultrasound Methods in the Emergency Department to Detect Pulmonary Congestion on Computed Tomography

2019 ◽  
Author(s):  
Kristina Cecilia Miger ◽  
Andreas Fabricius-Bjerre ◽  
Christian Peter Maschmann ◽  
Jesper Wamberg ◽  
Mathilde Marie Winkler Wille ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Pleural Effusion ◽  
Lung Ultrasound ◽  
Decompensated Heart Failure ◽  
Diagnostic Value ◽  
Chest Ct ◽  
Chronic Obstructive ◽  
Pulmonary Congestion ◽  
B Lines

Abstract Background B-lines on lung ultrasound are seen in decompensated heart failure, but their diagnostic value in consecutive patients in the acute setting is not clear. Chest CT is the superior method to evaluate interstitial lung disease, but no studies have compared lung ultrasound directly to congestion on chest CT. Purpose To examine whether congestion on lung ultrasound equals congestion on a low-dose chest CT as the gold standard. Materials and Methods In a single-center, prospective observational study we included consecutive patients ≥ 50 years of age in the emergency department. Patients were concurrently examined by lung ultrasound and chest CT. Congestion on lung ultrasound was examined in three ways: I) the total number of B-lines, II) ≥ 3 B-lines bilaterally, III) ≥ 3 B-lines bilaterally and/or bilateral pleural effusion. Congestion on CT was assessed by two specialists blinded to all other data. Results We included 117 patients, 27 % of whom had a history of heart failure and 52 % chronic obstructive pulmonary disease. Lung ultrasound and CT were performed within a median time of 79.0 minutes. Congestion on CT was detected in 32 patients (27 %). Method I had an optimal cut-point of 7 B-lines with a sensitivity of 72 % and a specificity of 81 % for congestion. Method II had 44 % sensitivity, and 94 % specificity. Method III had a sensitivity of 88 % and a specificity of 85 %. Conclusion Pulmonary congestion in consecutive dyspneic patients ≥ 50 years of age is better diagnosed if lung ultrasound evaluates both B-lines and pleural effusion instead of B-lines alone.

scholarly journals Effects of Orthostatic Position in Point of Care Lung Ultrasound in Acute Decompensated Heart Failure; a Potential for Simple Interventions

2019 ◽  
Vol 25 (8) ◽  
pp. S133-S134
Author(s):  
Kenneth C. Bedi ◽  
Cosette C. Motta ◽  
Matthew J. Fink ◽  
Todd Nicklas ◽  
Kenneth B. Margulies
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Orthostatic Position
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