Department of Emergency Medicine, Antalya Atatürk State Hospital, Antalya, Turkey.
Department of Emergency Medicine, Health Sciences University, Antalya Education and Research Hospital, Antalya, Turkey.
J Ultrasound Med. 2021 Apr;40(4):751-761. doi: 10.1002/jum.15447. Epub 2020 Aug 31.
This prospective study was performed to evaluate the diagnostic role of point-of-care lung ultrasound (LUS) and inferior vena cava (IVC) ultrasound in patients with acute decompensated heart failure (ADHF).
A prospective cohort study was conducted between January 2018 and November 2018 on patients with a diagnosis of ADHF in the emergency department (ED). On admission, LUS findings, inspiratory and expiratory IVC diameters, and the inferior vena cava collapsibility index (IVCCI) were obtained. After therapeutic interventions, third-hour changes in LUS and the IVC index and the treatment response were assessed.
Eighty patients were enrolled. Forty-six (58%) patients had an ejection fraction (EF) greater than 40%, and 34 (42%) had an EF of less than 40%. Significant differences were detected between the admission and third-hour inspiratory IVC diameter, expiratory IVC diameter, and IVCCI (P = .001). There was no correlation between the EF and inspiratory IVC diameter (r = -0.03; P = .976), expiratory IVC diameter (r = -109; P = .336), or IVCCI (r = -0.72; P = .523) and between the B-type natriuretic peptide level and inspiratory IVC diameter (r = -0.58; P = .610), expiratory IVC diameter (r = -0.33; P = .774), or IVCCI (r = -0.78; P = .493) either. A comparison of admission and third-hour numbers of B-lines on LUS imaging showed a significant decrease in the number of B-lines in all zones at the end of 3 hours (P = .001). A significant difference existed between the hospitalized and discharged patients with respect to IVC diameters and number of B-lines.
In the ED setting, an assessment of B-lines and measurement of IVC diameters are better markers than the B-type natriuretic peptide level, EF, or chest x-ray for diagnosis of ADHF and can be used to make decisions for hospitalization or discharge from the ED.
本前瞻性研究旨在评估即时床边肺部超声（LUS）和下腔静脉（IVC）超声在急性失代偿性心力衰竭（ADHF）患者中的诊断作用。
本前瞻性队列研究于 2018 年 1 月至 11 月在急诊科（ED）诊断为 ADHF 的患者中进行。入院时，获取 LUS 检查结果、吸气和呼气 IVC 直径以及下腔静脉塌陷指数（IVCCI）。在治疗干预后，评估 LUS 和 IVC 指数的第 3 小时变化以及治疗反应。
共纳入 80 例患者。46 例（58%）患者的射血分数（EF）大于 40%，34 例（42%）患者的 EF 小于 40%。入院时和第 3 小时吸气 IVC 直径、呼气 IVC 直径和 IVCCI 之间存在显著差异（P=0.001）。EF 与吸气 IVC 直径（r=-0.03；P=0.976）、呼气 IVC 直径（r=-109；P=0.336）或 IVCCI（r=-0.72；P=0.523）之间无相关性，B 型利钠肽水平与吸气 IVC 直径（r=-0.58；P=0.610）、呼气 IVC 直径（r=-0.33；P=0.774）或 IVCCI（r=-0.78；P=0.493）之间也无相关性。LUS 成像上的 B 线数量在入院和第 3 小时的比较显示，3 小时结束时所有区域的 B 线数量均显著减少（P=0.001）。IVC 直径和 B 线数量在住院和出院患者之间存在显著差异。
在 ED 环境中，B 线评估和 IVC 直径测量比 B 型利钠肽水平、EF 或胸部 X 线更能诊断 ADHF，可用于决定 ED 住院或出院。
