Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting

Gregor Prosen (Author), Petra Klemen (Author), Matej Strnad (Author), Štefek Grmec (Author)

Abstract

Introduction: We studied the diagnostic accuracy of bedside lung ultrasound (the presence of a comet tail sign), N-terminal pro-brain natriuretic peptide (NT-proBNP), and clinical assessment (modified Boston criteria) in differentiating heart failure (HF)- related acute dyspnea from pulmonary (COPD/asthma) related acute dyspnea in the prehospital setting. Methods: Prospective study was performed at the Center for Emergency Medicine Maribor, Slovenia, between July 2007 and April 2010. Two groups of patients were compared: HF-related acute dyspnea group (n = 129) vs pulmonary-related (asthma/COPD) acute dyspnea group (n = 89). All patients underwent lung ultrasound examination, along with basic laboratory, rapid NT-proBNP testing and chest X-ray. Results: Ultrasound comet tail sign has 100% sensitivity, 95% specificity, 100% negative predictive value (NPV) and 96% positive predictive value (PPV) for the diagnosis of HF. NT-proBNP (cut-off point 1000 pg/ml) has 92% sensitivity, 89% specificity, 86% NPV and 90% PPV. Boston modified criteria have 85% sensitivity, 86% specificity, 80% NPV and 90% PPV. Comparing the three methods, we found significant differences between ultrasound sign vs NT-proBNP (P<0.05) and Boston modified criteria (P<0.05). Combination of ultrasound sign and NT-proBNP has 100% sensitivity, 100% specificity, 100% NPV and 100% PPV. With ultrasound we can exclude HF in patients with pulmonary related dyspnea who have positive NT-proBNP (> 1000 pg/ml) and previous history of HF. Conclusions: Ultrasound comet tail sign alone or in combination with NT-proBNP has a high diagnostic accuracy in differentiating between acute HF and COPD/asthma causes of acute dyspnea in prehospital emergency setting.

Keywords

lungs;ultrasound;N-terminal pro-brain natriuretic peptide;acute heart failure;chronic obstructive pulmonary disease;asthma;acute dyspnea;

Data

Language:	English
Year of publishing:	2011
Typology:	1.01 - Original Scientific Article
Organization:	UM MF - Faculty of Medicine
UDC:	616.24-008.4-083.98
COBISS:	3911231
ISSN:	1466-609X
Views:	1382
Downloads:	345
Average score:	0 (0 votes)
Metadata:

Other data

Secondary language:	Slovenian
Secondary keywords:	Heart Arrest;Srčni zastoj;Pulmonary Disease, Chronic Obstructive;Kronična obstruktivna pljučna bolezen;Asthma;Astma;Dyspnea;Dispneja;Lung;ultrasonography;Pljuča;Ultrasonografija;Natriuretic Peptide, Brain;Natriuretični peptid, možganski;Emergency Medicine;Nujna medicina;
URN:	URN:SI:UM:
Type (COBISS):	Scientific work
Pages:	str. R114
Volume:	ǂVol. ǂ15
Issue:	ǂno. ǂ2
Chronology:	2011
DOI:	10.1186/cc10140
ID:	10845022