急诊多普勒超声心动图诊断急性呼吸困难患者急性左心衰竭的准确性：与波士顿标准和 N 末端脑利钠肽原的比较。

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.

机构信息

Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

出版信息

Acad Emerg Med. 2010 Jan;17(1):18-26. doi: 10.1111/j.1553-2712.2009.00630.x.

DOI:10.1111/j.1553-2712.2009.00630.x

PMID:20078435

Abstract

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.

摘要

目的

超声心动图是诊断急性左心室心力衰竭（aLVHF）的基本工具。然而，并非每个急诊部（ED）都常规提供咨询检查。作者研究了急诊医师（EP）进行的急诊多普勒超声心动图（EDecho）在诊断急性呼吸困难患者的 aLVHF 中的诊断性能。

方法

评估了急性呼吸困难患者的便利样本。对于每个患者，计算心力衰竭的波士顿标准评分，并同时进行 N 末端脑钠肽前体（NT-proBNP）和 EDecho。在经过有限的超声心动图课程后，四位研究者进行了 EDecho，并对二尖瓣流入的脉冲多普勒分析进行了“限制”模式评估，并评估了左心室（LV）射血分数降低。除了 NT-proBNP 和 EDecho 结果之外，回顾所有患者的临床数据后得出最终诊断，作为标准诊断。

结果

在 145 名患者中，有 64 名（44％）被诊断为 aLVHF。进行 EDecho 所需的中位数时间为 4 分钟。在 125 名患者中可行脉冲多普勒分析（84％）。与降低的 LV 射血分数相比，限制模式更敏感（82％）和特异（90％），并且比波士顿标准和 NT-proBNP 更特异诊断 aLVHF。考虑到限制模式的不可解释值以及波士顿标准（4 < Boston 标准评分 < 7）和 NT-proBNP（300 < NT-proBNP < 2,200 pg/mL）的不确定值（“灰色区域”）作为假结果，限制模式在整个人群中的准确性为 75％，而 NT-proBNP 和波士顿标准的准确性分别为 49％。