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Original Research: Pulmonary Vascular Disease |

Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the EDLung Ultrasound in Diagnosing Acute Heart Failure: A SIMEU Multicenter Study

Emanuele Pivetta, MD; Alberto Goffi, MD; Enrico Lupia, MD, PhD; Maria Tizzani, MD; Giulio Porrino, MD; Enrico Ferreri, MD; Giovanni Volpicelli, MD, FCCP; Paolo Balzaretti, MD; Alessandra Banderali, MD; Antonello Iacobucci, MD; Stefania Locatelli, MD; Giovanna Casoli, MD; Michael B. Stone, MD; Milena M. Maule, PhD; Ileana Baldi, PhD; Franco Merletti, MD; Gian Alfonso Cibinel, MD; for the SIMEU Group for Lung Ultrasound in the Emergency Department in Piedmont
Author and Funding Information

From the Cancer Epidemiology Unit (Drs Pivetta, Maule, Baldi, and Merletti), Department of Medical Sciences, CeRMS and University of Turin, Turin, Italy; Department of Emergency Medicine (Drs Pivetta and Cibinel), “E. Agnelli” General Hospital, Pinerolo, Turin, Italy; Department of Emergency Medicine (Drs Pivetta and Stone), Brigham and Women’s Hospital, Boston, MA; Department of Emergency Medicine (Drs Pivetta, Lupia, Tizzani, Porrino, Ferreri, and Locatelli), A.O.U. Città della Salute e della Scienza di Torino and University of Turin, Turin, Italy; Interdepartmental Division of Critical Care Medicine (Dr Goffi), University of Toronto, Toronto, ON, Canada; Toronto Western Hospital (Dr Goffi), University Health Network, Toronto, ON, Canada; Department of Medical Sciences (Dr Lupia), University of Turin, Turin, Italy; Department of Emergency Medicine (Dr Volpicelli), “San Luigi Gonzaga” University Hospital, Orbassano, Turin, Italy; Department of Emergency Medicine (Dr Balzaretti), “Ordine Mauriziano” Hospital, Turin, Italy; Department of Emergency Medicine (Dr Banderali), “Cardinal Massaia” Hospital, Asti, Italy; Department of Emergency Medicine (Dr Iacobucci), “Santa Croce e Carle” Hospital, Cuneo, Italy; Department of Emergency Medicine (Dr Casoli), “Martini” Hospital, Turin, Italy; and Department of Cardiac, Thoracic, and Vascular Sciences (Dr Baldi), University of Padova, Padova, Italy.

CORRESPONDENCE TO: Emanuele Pivetta, MD, Department of Medical Sciences, Cancer Epidemiology Unit, A.O.U. Città della Salute e della Scienza di Torino, Via Santena 7, 10126, Torino, Italy; e-mail: emanuele.pivetta@gmail.com


Partial data from this study were presented at the European Society of Cardiology 2013 Annual Meeting, August 31-September 4, 2013, Amsterdam, The Netherlands; American College of Emergency Physicians 2012 Scientific Assembly, October 8-11, 2012, Denver, CO; and the American Institute of Ultrasound in Medicine 2013 Annual Meeting, April 7-11, 2013, New York, NY.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):202-210. doi:10.1378/chest.14-2608
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BACKGROUND:  Lung ultrasonography (LUS) has emerged as a noninvasive tool for the differential diagnosis of pulmonary diseases. However, its use for the diagnosis of acute decompensated heart failure (ADHF) still raises some concerns. We tested the hypothesis that an integrated approach implementing LUS with clinical assessment would have higher diagnostic accuracy than a standard workup in differentiating ADHF from noncardiogenic dyspnea in the ED.

METHODS:  We conducted a multicenter, prospective cohort study in seven Italian EDs. For patients presenting with acute dyspnea, the emergency physician was asked to categorize the diagnosis as ADHF or noncardiogenic dyspnea after (1) the initial clinical assessment and (2) after performing LUS (“LUS-implemented” diagnosis). All patients also underwent chest radiography. After discharge, the cause of each patient’s dyspnea was determined by independent review of the entire medical record. The diagnostic accuracy of the different approaches was then compared.

RESULTS:  The study enrolled 1,005 patients. The LUS-implemented approach had a significantly higher accuracy (sensitivity, 97% [95% CI, 95%-98.3%]; specificity, 97.4% [95% CI, 95.7%-98.6%]) in differentiating ADHF from noncardiac causes of acute dyspnea than the initial clinical workup (sensitivity, 85.3% [95% CI, 81.8%-88.4%]; specificity, 90% [95% CI, 87.2%-92.4%]), chest radiography alone (sensitivity, 69.5% [95% CI, 65.1%-73.7%]; specificity, 82.1% [95% CI, 78.6%-85.2%]), and natriuretic peptides (sensitivity, 85% [95% CI, 80.3%-89%]; specificity, 61.7% [95% CI, 54.6%-68.3%]; n = 486). Net reclassification index of the LUS-implemented approach compared with standard workup was 19.1%.

CONCLUSIONS:  The implementation of LUS with the clinical evaluation may improve accuracy of ADHF diagnosis in patients presenting to the ED.

TRIAL REGISTRY:  Clinicaltrials.gov; No.: NCT01287429; URL: www.clinicaltrials.gov

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