肺部超声 B 线量化在 COPD 加重期心力衰竭标志物中的价值。
Value of Lung Ultrasound Sonography B-Lines Quantification as a Marker of Heart Failure in COPD Exacerbation.
机构信息
Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia.
Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.
出版信息
Int J Chron Obstruct Pulmon Dis. 2024 Aug 1;19:1767-1774. doi: 10.2147/COPD.S447819. eCollection 2024.
INTRODUCTION
Identifying heart failure (HF) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can be challenging. Lung ultrasound sonography (LUS) B-lines quantification has recently gained a large place in the diagnosis of HF, but its diagnostic performance in AECOPD remains poorly studied.
PURPOSE
This study aimed to assess the contribution of LUS B-lines score (LUS score) in the diagnosis of HF in AECOPD patients.
PATIENTS AND METHODS
This is a prospective cross-sectional multicenter cohort study including patients admitted to the emergency department for AECOPD. All included patients underwent LUS. A lung ultrasound score (LUS score) based on B-lines calculation was assessed. A cardiac origin of dyspnea was retained for a LUS score greater than 15. HF diagnosis was based on clinical examination, pro-brain natriuretic peptide levels, and echocardiographic findings. The LUS score diagnostic performance was assessed by receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio at the best cutoffs.
RESULTS
We included 380 patients, mean age was 68±11.6 years, sex ratio (M/F) 1.96. Patients were divided into two groups: the HF group [n=157 (41.4%)] and the non-HF group [n=223 (58.6%)]. Mean LUS score was higher in the HF group (26.8±8.4 vs 15.3±7.1; <0.001). The mean LUS score in the HF patients with reduced LVEF was 29.2±8.7, and was 24.5±7.6 in the HF patients with preserved LVEF. LUS score area under ROC curve for the diagnosis of HF was 0.71 [0.65-0.76]. The best sensitivity (89% [85.9-92,1]) was observed at the threshold of 5; the best specificity (85% [81.4-88.6]) was observed at the threshold of 30. Correlation between LUS score and E/E' ratio was good (R=0.46, =0.0001).
CONCLUSION
Our results suggest that LUS score could be helpful and should be considered in the diagnostic approach of HF in AECOPD patients, at least as a ruling in test.
简介
在慢性阻塞性肺疾病急性加重（AECOPD）患者中识别心力衰竭（HF）可能具有挑战性。肺部超声声像图（LUS）B 线量化最近在 HF 诊断中占有重要地位，但在 AECOPD 中的诊断性能仍研究甚少。
目的
本研究旨在评估 LUS B 线评分（LUS 评分）在 AECOPD 患者 HF 诊断中的作用。
患者和方法
这是一项前瞻性的多中心队列研究，纳入因 AECOPD 而入住急诊科的患者。所有纳入的患者均接受 LUS 检查。评估基于 B 线计算的肺部超声评分（LUS 评分）。如果 LUS 评分大于 15，则保留呼吸困难的心脏来源。HF 的诊断基于临床检查、脑利钠肽前体水平和超声心动图结果。通过接收者操作特征（ROC）曲线、灵敏度、特异性和最佳截断值处的似然比评估 LUS 评分的诊断性能。
结果
我们纳入了 380 例患者，平均年龄为 68±11.6 岁，男女比例为 1.96。患者分为两组：HF 组[157 例（41.4%）]和非 HF 组[223 例（58.6%）]。HF 组的平均 LUS 评分较高（26.8±8.4 比 15.3±7.1；<0.001）。LVEF 降低的 HF 患者的平均 LUS 评分为 29.2±8.7，LVEF 正常的 HF 患者的平均 LUS 评分为 24.5±7.6。LUS 评分对 HF 诊断的 ROC 曲线下面积为 0.71[0.65-0.76]。最佳灵敏度（89%[85.9-92.1]）为 5 时，最佳特异性（85%[81.4-88.6]）为 30 时。LUS 评分与 E/E' 比值之间存在良好相关性（R=0.46，=0.0001）。
结论
我们的结果表明，LUS 评分可能有助于在 AECOPD 患者 HF 的诊断方法中考虑，至少作为一种辅助检测手段。
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