Cardiology Department, Habib Thameur Hospital, Tunis 1008, Tunisia.
Cardiology Department, Hedi Chaker Hospital, Sfax 3000,Tunisia.
Curr Probl Cardiol. 2025 Jan;50(1):102910. doi: 10.1016/j.cpcardiol.2024.102910. Epub 2024 Oct 28.
One of the most prevalent causes of emergency room visits is acute dyspnea. Several etiologies, including cardiac, pulmonary, metabolic, psychogenic etc… may be involved. Acute heart failure (AHF) is among the most common causes. This study aims to evaluate, in patients presenting with acute dyspnea to the emergency departement (ED), the accuracy of a diagnostic approach combining Lung ultrasonography (LUS) and clinical assessment as compared to the traditional AHF diagnostic work-up.
This is a bi-centric cross-sectional observational study, conducted at the Emergency and Cardiology Department of both the Hedi Chaker Hospital in Sfax and the Habib Thameur Hospital in Tunis for the period extending from 01/07/2022 to 30/09/2023. The diagnostic performance of pulmonary ultrasonography was studied and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared with those of clinical examination, chest X-Ray, NT-pro -BNP and the Transthoracic echocardiography (TTE) which was the reference exam.
The most common cause of acute dyspnea is acute heart failure (79.3 %). LUS had a sensitivity of 94,2 % in diagnosing AHF and a specificity of 77,5 %. Its PPV and NPV were respectively 92 % and 81 %. The area under curbe (AUC) of B-Lines required for the diagnosis of interstitial pulmonary syndrome was excellent (92 %). There was a moderate significant positive correlation between the number of B-Lines and NT-Pro-BNP levels r = 0.51, P < 0.001. Also, there was a very strong significant positive relationship between the pulmonary congestion assessed by LUS and Left atrium - pressure r = 0.788, P < 0.001 CONCLUSION: LUS is an excellent test both to confirm and exclude the diagnosis of AHF in patients consulting the emergency room for acute dyspnea and therefore deserves to be performed systematically.
急诊室就诊最常见的原因之一是急性呼吸困难。可能涉及多种病因，包括心脏、肺部、代谢、心理等。急性心力衰竭（AHF）是最常见的原因之一。本研究旨在评估在因急性呼吸困难就诊于急诊部（ED）的患者中，将肺部超声（LUS）与临床评估相结合的诊断方法与传统 AHF 诊断方法相比的准确性。
这是一项在 2022 年 7 月 1 日至 2023 年 9 月 30 日期间在 Sfax 的 Hedi Chaker 医院和 Tunis 的 Habib Thameur 医院的急诊和心脏病科进行的双中心横断面观察性研究。研究了肺部超声的诊断性能，并比较了其与临床检查、胸部 X 光、NT-pro-BNP 和经胸超声心动图（TTE）（参考检查）的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
急性呼吸困难最常见的原因是急性心力衰竭（79.3%）。LUS 诊断 AHF 的敏感性为 94.2%，特异性为 77.5%。其 PPV 和 NPV 分别为 92%和 81%。用于诊断间质性肺综合征的 B 线数量的曲线下面积（AUC）为优秀（92%）。B 线数量与 NT-Pro-BNP 水平之间存在中度显著正相关 r = 0.51，P < 0.001。此外，LUS 评估的肺充血与左心房压力之间存在很强的显著正相关 r = 0.788，P < 0.001。
LUS 是一种极好的检查方法，可用于确认和排除因急性呼吸困难就诊于急诊室的患者的 AHF 诊断，因此值得系统进行。
