scholarly journals Ability of non-physicians to perform and interpret lung ultrasound: A systematic review

2019 ◽  
Vol 18 (6) ◽  
pp. 474-483 ◽  
Author(s):  
Varsha Swamy ◽  
Philip Brainin ◽  
Tor Biering-Sørensen ◽  
Elke Platz
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Ultrasound Images ◽  
Pulmonary Congestion ◽  
Pleural Effusions ◽  
Brief Training ◽  
Online Databases ◽  
B Lines

Background: Lung ultrasound is a useful tool in the assessment of pulmonary congestion in heart failure that is typically performed and interpreted by physicians at the point-of-care. Aims: To investigate the ability of nurses, students, and paramedics to accurately identify B-lines and pleural effusions for the detection of pulmonary congestion in heart failure and to examine the training necessary. Methods and results: We conducted a systematic review and searched online databases for studies that investigated the ability of nurses, students, and paramedics to perform lung ultrasound and detect B-lines and pleural effusions. Of 979 studies identified, 14 met our inclusion criteria: five in nurses, eight in students, and one in paramedics. After 0–12 h of didactic training and 58–62 practice lung ultrasound examinations, nurses were able to identify B-lines and pleural effusions with a sensitivity of 79–98% and a specificity of 70–99%. In image adequacy studies, medical students with 2–9 h of training were able to acquire adequate images for B-lines and pleural effusions in 50–100%. Only one eligible study investigated paramedic-performed lung ultrasound which did not support the ability of paramedics to adequately acquire and interpret lung ultrasound images after 2 h of training. Conclusions: Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases. The examination of heart failure patients with lung ultrasound by non-clinicians appears feasible and warrants further investigation.

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 Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review

2017 ◽  
Vol 19 (9) ◽  
pp. 1154-1163 ◽  
Author(s):  
Elke Platz ◽  
Allison A. Merz ◽  
Pardeep S. Jhund ◽  
Ali Vazir ◽  
Ross Campbell ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Chronic Heart Failure ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Pulmonary Congestion ◽  
Dynamic Changes

scholarly journals P1479 Prognostic value of integrated cardiopulmonary ultrasound in heart failure patients with reduced and preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Gargani ◽  
N Pugliese ◽  
F Frassi ◽  
S Masi ◽  
P Landi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Univariate Analysis ◽  
Vena Cava ◽  
Pulmonary Congestion ◽  
Echocardiographic Parameters ◽  
Ultrasound Assessment ◽  
B Lines

Abstract Background Lung-ultrasound B-lines are the sonographic sign of pulmonary congestion and are present in patients with heart failure (HF). Their role as a diagnostic marker is quite established since they can be used for the differential diagnosis of dyspnea to both rule in or rule out HF, whereas their prognostic value at admission is less known. Purpose To assess the prognostic value of B-lines at admission in patients admitted to a Cardiology Department with a diagnosis of HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction. Methods We enrolled a total of 310 consecutive in-patients (aged 69 ± 12 years, 751 males) who underwent on admission a two-dimensional and Doppler echocardiographic evaluation coupled with lung ultrasound assessment of B-lines, according to standardised protocols. The total number of B-line was obtained by summing the number of B-lines from 28 scanning sites on the anterior and lateral right and left hemithorax, as previously described. Results All patients were followed-up for a median period of 15 (interquartile range: 5-28) months for death and HF readmission. During the follow-up, 79 events occurred. Among standard echocardiographic parameters, ejection fraction (EF) <50%, tricuspid annular plane systolic excursion (TAPSE) < 17 mm, pulmonary artery systolic pressure (PASP) ³35 mmHg, inferior vena cava diameter >21 mm and total B-lines ³30 were predictors of events at univariate analysis, whereas only B-lines ³30 (hazard ratio [HR] 2.06; 95% confidence interval [CI] 1.04-4.10) and TAPSE <17 mm (HR 0.53; CI 0.29-0.97) were independent predictors at multivariate analysis. When analysing separately HFpEF patients (105 patients, 33.9%), B-lines ³30 was the only independent predictor of events (HR 6.11; CI 1.49-25.05) (Figure). Conclusions B-lines are a simple, user-friendly, bedside echographic sign of pulmonary congestion, that provides useful information not only for the diagnosis but also for the prognosis of HF patients. Their added value among standard echocardiographic parameters is stronger in patients with HFpEF compared to HFrEF. An integrated cardiopulmonary ultrasound assessment at HF admission provides excellent value for both diagnostic and prognostic stratification. Abstract P1479 Figure

scholarly journals Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Stefano Coiro ◽  
Guillaume Porot ◽  
Patrick Rossignol ◽  
Giuseppe Ambrosio ◽  
Erberto Carluccio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Poor Prognosis ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Systolic Arterial Pressure ◽  
Lung Ultrasonography ◽  
Pulmonary Congestion ◽  
Prognostic Role ◽  
Heart Failure Hospitalisation ◽  
B Lines

Abstract Pulmonary congestion assessed at discharge by lung ultrasonography predicts poor prognosis in heart failure (HF) patients. We investigated the association of B-lines with indices of hemodynamic congestion [BNP, E/e’, pulmonary systolic arterial pressure (PAPs)] in HF patients, and their prognostic value overall and according to concomitant atrial fibrillation (AF), reduced (≤40%) ejection fraction (EF), and timing of quantification during hospitalisation for heart failure (HHF). In 110 HHF patients, B-lines were highly discriminative of BNP >400 pg/ml (AUC ≥ 0.80 for all), and moderately discriminative of PAPs >50 mmHg (AUC = 0.68, 0.56 to 0.80); conversely, B-lines poorly discriminated average E/e’ ≥ 15, except at discharge. B-line count significantly predicted mid-term recurrent HHF or death (overall and in subgroups), regardless of AF status, EF, and timing of quantification during HHF (all p for interaction >0.10). regardless, B-lines ≥30 at discharge were most predictive of outcome (HR = 7.11, 2.06–24.48; p = 0.002) while B-lines ≥45 early during HHF were most predictive of outcome (HR = 9.20, 1.82–46.61; p = 0.007). Lung ultrasound was able to identify patients with high BNP levels, but not with increased E/e’, also showing a prognostic role regardless of AF status, EF or timing of quantification; best B-line cut-off appears to vary according to the timing of quantification during hospitalization.

scholarly journals PREDISCHAGE LUNG ULTRASOUND AS A PREDICTOR OF REHOSPITALIZATION OR MORTALITY ACUTE HEART FAILURE PATIENTS

2020 ◽  
Vol 7 (8) ◽  
pp. 28-34
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Acute Heart Failure ◽  
Lung Ultrasound ◽  
Independent Predictor ◽  
Hypertensive Heart Disease ◽  
Functional Class ◽  
Pulmonary Congestion ◽  
Class Iii ◽  
B Lines

Backgroud: Persistent congestion is a major cause of rehospitalization in patients with acute heart failure (AHF). Lung Ultrasound (LUS) is an easy and valid examination in assessing pulmonary congestion. The number of B-lines correlates very strongly with the amount of extravascular lung fluid (EVLW). The aim of this study is to determine if LUS pre-discharge can predict rehospitalization or mortality. Methods: This single centered cohort study included 127 consecutive AHF patients. LUS on 28 antorolateral chest wall segment was done double blindly before discharging the patient to calculate the B-line. Clinical data, Composite Congestion Score (CCS) and echocardiography were collected. Cox proportional hazard regression analysis was performed to assess the independent predictor of rehabilitation or mortality during 120 days of observation. Results: The patients were 57.4 ± 7.8 years old, most were male (66.9%), with LV EF 36.7 ± 7.2%. The etiology of heart failure was caused by coronary heart disease (56.7%) and hypertensive heart disease (40.9%). The median number of B-lines was 24 (15 - 39). Hospitalization or death occurred in 43 patients (33.8%) during the median observation of 120 days (73-120). Patients with B-line pre-discharge ≥30 had a lower mean survival (log rank X2 48.14; p <0.001). In multivariate analysis, B-line pre-discharge ≥30 was the strongest independent predictor of rehabilitation or mortality (HR 4.71; 95% CI 2.15 - 10.32). Other independent predictors are Composite Congestion Score (CCS) ≥ 3 (HR 4.26; 95% CI 2.07 - 8.77) and NYHA functional class III (HR 2.87; 95% CI 1.49 - 5, 53). Conclusion: Persistent pulmonary congestion in AHF patients as assessed by B-line pre-discharge ≥30 is a strong independent predictor of rehospitalization or mortality. LUS could potentially help to guide the timing of discharge from AHF hospitalization, the follow-up scheduling and the therapy tailoring. Further randomized clinical studies are needed to definitely support the routine use of LUS.

scholarly journals Pulmonary congestion by lung ultrasound in decompensated heart failure: associations, in-hospital changes, prognostic value

Kardiologiia ◽  
2019 ◽  
Vol 59 (8) ◽  
pp. 5-14 ◽  
Author(s):  
Zh. D. Kobalava ◽  
A. F. Safarova ◽  
A. E. Soloveva ◽  
F.E. Cabello ◽  
I. A. Meray ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Decompensated Heart Failure ◽  
Functional Class ◽  
Pulmonary Congestion ◽  
Cox Regression Analysis ◽  
History Of ◽  
B Lines

Background. Recently lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for assessment of pulmonary congestion (PC) in patients with decompensated heart failure (DHF).Objective: to assess the incidence, in-hospital changes and prognostic significance of PC assessed by LUS in DHF patients.Materials and methods. Routine clinical assessment and eight-zone LUS were performed in 162 patients with DHF (men 66%, mean age 68±12 years, hypertension 97%, history of myocardial infarction 44%, atrial fibrillation 60%, ejection fraction [EF] 40±14%, EF<40% 46%, baseline NT-proBNP 4 246 [1741; 6 837] pg/ml). Sum of B-lines ≤5 was considered as normal, 6-15, 16-30 and >30 - as mild, moderate and severe PC, respectively.Results. Using LUS on admission PC was diagnosed in all patients (moderate and severe in 31.5 and 67.3%, respectively). At discharge normal LUS profile was observed in 48.2% of patients. In 33.3, 14.8 and 3.7% of patients PC was mild, moderate, and severe, respectively. According to multivariable Cox regression analysis including age, sex, EF, NYHA functional class, and jugular venous distension sum of B-lines >5 at discharge was associated with higher probability of 12-month all-cause death (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.15-7.13, p=0.024), sum of B-lines >15 - with higher probability of HF readmission (HR 2.83, 95%CI 1.41-5.67, p=0.003).Conclusion. During hospital stay the incidence of PC as assessed by LUS decreased from 100 to 52% of patients. Sum of B-lines >5 at discharge was independently associated with higher risk of 12-month all-cause death, >15 - with higher risk of 12-month HF readmission.

Simple and additive diagnostic modalities for the screening of heart failure with preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Illes ◽  
G Agoston ◽  
L Gargani ◽  
I Szabo ◽  
N Polestyuk-Nemeth ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Lung Ultrasound ◽  
High Morbidity ◽  
Pulmonary Congestion ◽  
Left Atrial Strain ◽  
Diagnostic Power ◽  
Atrial Strain ◽  
B Lines

Abstract Background Nearly half of all patients with heart failure (HF) symptoms have an EF that is preserved (HFpEF). The prevalence of HFpEF is rising, with high morbidity, mortality. The diagnosis of HFpEF is particularly challenging. Lung ultrasound (LUS) and left atrial strain are promising screening and diagnostic tools to assess pulmonary congestion and left atrial dysfunction in patients with suspected HFpEF. Aim To evaluate the relationship between patients symptoms, pro-BNP level with LUS and left atrial strain, as well to assess the diagnostic power of B-lines in HFpEF population. Methods 82 consecutive patients (57 women, mean age 70±6 years) with clinical signs of heart failure were prospectively enrolled. Exclusion criteria were: ejection fraction &lt;55%, more than mild mitral and/or aortic valve disease, pulmonary disease, pulmonary arterial hypertension. Within one hour all patients underwent comprehensive echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-LASr), lung ultrasound assessment of B-lines on the anterolateral and posterior chest wall, and NT-proBNP levels. Results In 45 patients (54%) a significant number of B-lines (≥15) were observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p&lt;0.0001, r=0.67), left atrial volume (p&lt;0.0001, r=0.45), and LASr (p&lt;0.005, r=−0.4). We also found week correlation between the number of B-lines and E/e' ratio (p&lt;0.003, r=0.3), and between E/e' ratio and NT-proBNP level (p&lt;0.05, r=0.2). We also assessed the diagnostic ability of B-lines to predict markedly elevated pro-BNP level (≥125pg/ml), AUC was 0.85, with specificity of 64% and sensitivity of 85% (Figure 1). The number of B lines also correlated with the H2FPEF score (p&lt;0.001, r=0.4). Conclusion LUS is a simple, feasible tool to detect pulmonary congestion in HFpEF and it has an adequate diagnostic power to predict elevated NTpro-BNP level. LASr is promising too, which better reflects pulmonary congestion and elevated NT-proBNP values than the conventional echocardiographic parameters. Figure 1. ROC curve Blines predict high NTproBNP Funding Acknowledgement Type of funding source: None

P1481B-lines and left atrial strain in outpatients with suspected heart failure with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Agoston ◽  
L Gargani ◽  
I Szabo ◽  
B Illes ◽  
A Varga
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Lung Ultrasound ◽  
Preserved Ejection Fraction ◽  
Pulmonary Congestion ◽  
Left Atrial Strain ◽  
Atrial Strain ◽  
Left Atrial Dysfunction ◽  
B Lines

Abstract Background Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing healthcare burden and its prevalence is increasing. Diagnosing HFpEF is challenging. Lung ultrasound (LUS) and left atrial strain are promising tools to assess pulmonary congestion and left atrial dysfunction in outpatient settings in patients with suspected HFpEF. Aim To evaluate the correlation of LUS B-lines with left atrial strain in patients with HFpEF. Methods Thirty-six consecutive patients (24 women, mean age 70±6 years) with clinical signs of heart failure were prospectively enrolled. Exclusion criteria were: ejection fraction <55%, more than mild mitral and/or aortic valve disease, pulmonary disease, pulmonary arterial hypertension. Within one hour all patients underwent comprehensive echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-PALS), lung ultrasound assessment of B-lines on the antero-lateral and posterior chest wall, and NT-proBNP levels. Results The mean ejection fraction was 65.5±8.6%. In 28 patients (85%) a significant number of B-lines (≥15) was observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p<0.0001, r: 0.76, Figure 1.), left atrial volume (p<0.05, r: 0.45), and PALS (p<0.05, r: −0.5, Figure 2.). We didn't found any correlation between the number of B-lines and E/e'ratio (p=0.1, r: 0.28), or between E/e' ratio and NT-proBNP level (p=0.2, r: 0.2). Conclusion LUS is a simple, feasible tool to detect pulmonary congestion in HFpEF and it seems to better characterize these patients. B-lines correlate well with NT-proBNP values and with parameters of left atrial dysfunction. PALS is a promising too which better reflects pulmonary congestion and elevated NT-proBNP values than the conventional echocardiographic parameter E/e'.

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.

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