Document Detail


Diagnostic accuracy of emergency Doppler echocardiography for identification of acute left ventricular heart failure in patients with acute dyspnea: comparison with Boston criteria and N-terminal prohormone brain natriuretic peptide.
MedLine Citation:
PMID:  20078435     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Echocardiography is a fundamental tool in the diagnosis of acute left ventricular heart failure (aLVHF). However, a consultative exam is not routinely available in every emergency department (ED). The authors investigated the diagnostic performance of emergency Doppler echocardiography (EDecho) performed by emergency physicians (EPs) for the diagnosis of aLVHF in patients with acute dyspnea. METHODS: A convenience sample of acute dyspneic patients was evaluated. For each patient, the Boston criteria score for heart failure was calculated, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) and EDecho were contemporaneously performed. Four investigators, after a limited echocardiography course, performed EDechos and evaluated for a "restrictive" pattern on pulsed Doppler analysis of mitral inflow and reduced left ventricular (LV) ejection fraction. The final diagnosis, established after reviewing all patient clinical data except NT-proBNP and EDecho results, served as the criterion standard. RESULTS: Among 145 patients, 64 (44%) were diagnosed with aLVHF. The median time needed to perform EDecho was 4 minutes. Pulsed Doppler analysis was feasible in 125 patients (84%). The restrictive pattern was more sensitive (82%) and specific (90%) than reduced LV ejection fraction and more specific than the Boston criteria and NT-proBNP for the diagnosis of aLVHF. Considering noninterpretable values of the restrictive pattern and uncertain values ("gray areas") of Boston criteria (4 < Boston criteria score < 7) and of NT-proBNP (300 < NT-proBNP < 2,200 pg/mL) as false results, the accuracy of the restrictive pattern in the overall population was 75%, compared with accuracy of 49% for both NT-proBNP and Boston criteria. CONCLUSIONS: EDecho, particularly pulsed Doppler analysis of mitral inflow, is a rapid and accurate diagnostic tool in the evaluation of patients with acute dyspnea.
Authors:
Peiman Nazerian; Simone Vanni; Maurizio Zanobetti; Gianluca Polidori; Giuseppe Pepe; Roberto Federico; Elisabetta Cangioli; Stefano Grifoni
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  17     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-18     Completed Date:  2010-04-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-26     Citation Subset:  IM    
Copyright Information:
(c) 2010 by the Society for Academic Emergency Medicine.
Affiliation:
Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. pnazerian@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Dyspnea / etiology
Echocardiography, Doppler / methods,  standards*
Female
Heart Failure / blood,  complications,  diagnosis*
Hospitals, University
Humans
Immunoassay
Male
Middle Aged
Natriuretic Peptide, Brain / diagnostic use*
Peptide Fragments / diagnostic use*
Prospective Studies
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Peptide Fragments; 114471-18-0/Natriuretic Peptide, Brain

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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