Center for Emergency Medicine, Ulica talcev 9, 2000 Maribor, Slovenia.
Crit Care. 2011;15(2):R114. doi: 10.1186/cc10140. Epub 2011 Apr 14.
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 (according to the modified Boston criteria) in differentiating heart failure (HF)-related acute dyspnea from pulmonary (chronic obstructive pulmonary disease (COPD)/asthma)-related acute dyspnea in the prehospital setting.
Our prospective study was performed at the Center for Emergency Medicine, Maribor, Slovenia, between July 2007 and April 2010. Two groups of patients were compared: a HF-related acute dyspnea group (n = 129) and a pulmonary (asthma/COPD)-related acute dyspnea group (n = 89). All patients underwent lung ultrasound examinations, along with basic laboratory testing, rapid NT-proBNP testing and chest X-rays.
The 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 (cutoff point 1,000 pg/mL) has 92% sensitivity, 89% specificity, 86% NPV and 90% PPV. The Boston modified criteria have 85% sensitivity, 86% specificity, 80% NPV and 90% PPV. In comparing the three methods, we found significant differences between ultrasound sign and (1) NT-proBNP (P < 0.05) and (2) Boston modified criteria (P < 0.05). The combination of ultrasound sign and NT-proBNP has 100% sensitivity, 100% specificity, 100% NPV and 100% PPV. With the use of ultrasound, we can exclude HF in patients with pulmonary-related dyspnea who have positive NT-proBNP (> 1,000 pg/mL) and a history of HF.
An ultrasound comet-tail sign alone or in combination with NT-proBNP has high diagnostic accuracy in differentiating acute HF-related from COPD/asthma-related causes of acute dyspnea in the prehospital emergency setting.
ClinicalTrials.gov NCT01235182.
我们研究了床边肺部超声（彗星尾征的存在）、N 端脑利钠肽前体（NT-proBNP）和临床评估（根据改良波士顿标准）在鉴别院前心源性急性呼吸困难与肺部（慢性阻塞性肺疾病（COPD）/哮喘）相关急性呼吸困难中的诊断准确性。
我们的前瞻性研究于 2007 年 7 月至 2010 年 4 月在斯洛文尼亚马里博尔急救医学中心进行。比较了两组患者：心源性急性呼吸困难组（n=129）和肺部（哮喘/COPD）相关急性呼吸困难组（n=89）。所有患者均接受肺部超声检查、基础实验室检查、快速 NT-proBNP 检测和胸部 X 线检查。
超声彗星尾征对 HF 的诊断具有 100%的灵敏度、95%的特异性、100%的阴性预测值（NPV）和 96%的阳性预测值（PPV）。NT-proBNP（截断值 1000pg/ml）的灵敏度为 92%，特异性为 89%，NPV 为 86%，PPV 为 90%。改良波士顿标准的灵敏度为 85%，特异性为 86%，NPV 为 80%，PPV 为 90%。在比较这三种方法时，我们发现超声征象与（1）NT-proBNP（P<0.05）和（2）改良波士顿标准（P<0.05）之间存在显著差异。超声征象与 NT-proBNP 联合应用具有 100%的灵敏度、100%的特异性、100%的 NPV 和 100%的 PPV。在使用超声的情况下，我们可以排除那些具有肺部相关呼吸困难、NT-proBNP 阳性（>1000pg/ml）和 HF 病史的患者中的 HF。
在院前急救环境中，单独使用超声彗星尾征或联合使用 NT-proBNP 对鉴别急性 HF 相关与 COPD/哮喘相关原因引起的急性呼吸困难具有较高的诊断准确性。
ClinicalTrials.gov NCT01235182。
