Camacho Mariam B, Bagsic Samantha R Spierling, Camacho Santiago, Phan James N, Kimura Bruce J
Department of Medicine, Scripps Mercy Hospital, San Diego, CA, USA.
Department of Research and Development, Scripps Health, San Diego, CA, USA.
BMC Cardiovasc Disord. 2025 Aug 4;25(1):579. doi: 10.1186/s12872-025-05061-4.
Although lung ultrasound (LUS) can detect specific findings in decompensated congestive heart failure (dCHF), it is largely unavailable to hospitalized patients outside of point-of-care ultrasound practice. Therefore, we sought to determine if 4 lung views added value to echocardiography and whether LUS could be performed expeditiously in an inpatient echo lab.
Consecutive inpatient echo studies from a 300-bed community hospital included two posterobasal and two anteroapical lung views and were retrospectively reviewed for: (1) echo parameters including EF < 40%, E/e'>13, pseudonormal E/A ratio, among others, of which the presence of any one parameter defined an abnormal echocardiogram, Echo+, and (2) LUS bilateral findings of 3-or-more B-lines or pleural effusion defined an abnormal lung study, LUS+. Patient charts were reviewed for the clinical diagnosis of dCHF as the reference standard. Diagnostic accuracies were determined for Echo, LUS, and their combination in predicting dCHF by univariate and area under the receiver-operating characteristic (AUC) analyses. The time necessary to perform the LUS was recorded.
Of n = 129 inpatients, mean (±SD) patient age was 67.0 ± 16.3 years, 57% were male, 32/129 (25%) had dCHF. LUS + was present in 65/129 (50%) and was related to dCHF (p < 0.0001). Despite the high 91% sensitivity of Echo + alone, the addition of LUS findings improved specificity from 49 to 89% and accuracy from 60 to 84%. Lung imaging views required only 95 s ± 42 [range: 30-227] to perform.
The addition of 4 simple lung views to the standard echocardiogram improves diagnostic accuracy for decompensated CHF without increasing imaging resources. These pilot data support integrating lung ultrasound with standard echocardiography for healthcare delivery in hospital settings.
尽管肺部超声（LUS）能够检测失代偿性充血性心力衰竭（dCHF）的特定表现，但在即时超声检查实践之外，住院患者大多无法进行该项检查。因此，我们试图确定在超声心动图检查中增加4个肺部视图是否具有额外价值，以及LUS能否在住院患者超声心动图实验室中快速完成。
对一家拥有300张床位的社区医院的连续住院患者超声心动图检查进行回顾性分析，检查包括两个后基底段和两个前尖段肺部视图，并针对以下内容进行评估：（1）超声心动图参数，包括射血分数（EF）<40%、E/e'>13、假性正常E/A比值等，其中任何一项参数异常即定义为超声心动图异常（Echo+）；（2）LUS双侧检查发现3条及以上B线或胸腔积液即定义为肺部检查异常（LUS+）。查阅患者病历，以dCHF的临床诊断作为参考标准。通过单因素分析和受试者操作特征曲线下面积（AUC）分析，确定Echo、LUS及其联合检查在预测dCHF方面的诊断准确性。记录进行LUS所需的时间。
在129例住院患者中，患者平均（±标准差）年龄为67.0±16.3岁；57%为男性；32/129例（25%）患有dCHF。129例中有65例（50%）存在LUS+，且与dCHF相关（p<0.0001）。尽管单独的Echo+敏感性高达91%，但增加LUS检查结果后，特异性从49%提高到89%，准确性从60%提高到84%。进行肺部成像视图检查仅需95秒±42秒[范围：30 - 227秒]。
在标准超声心动图检查中增加4个简单的肺部视图可提高失代偿性CHF的诊断准确性，且无需增加成像资源。这些初步数据支持在医院环境中将肺部超声与标准超声心动图检查相结合用于医疗服务。
