Key result
Lung ultrasound detects HF pulmonary congestion with ~90% accuracy, outperforming exam and chest X-ray.
Why the study?
Physical examination and chest X-ray have limited accuracy in detecting pulmonary congestion in patients with heart failure, and the role of pulmonary ultrasound in different clinical scenarios needed systematic evaluation.
Systematic Review
May aid bedside congestion assessment in heart failure; leaves open impact on outcomes before changing practice.
Pulmonary congestion is an important clinical finding in patients with heart failure (HF). Physical examination and chest X-ray have limited accuracy in detecting congestion. Pulmonary ultrasound (PU) has been incorporated into clinical practice in the evaluation of pulmonary congestion. This paper aimed to perform a systematic review of the use of PU in patients with HF, in different scenarios. A search was performed in the MEDLINE and LILACS databases in February 2017 involving articles published between 2006 and 2016. We found 26 articles in the present review, 11 of which in the emergency setting and 7 in the outpatient setting, with diagnostic and prognosis defined value and poorly studied therapeutic value. PU increased accuracy by 90% as compared to physical examination and chest X-ray for the diagnosis of congestion, being more sensitive and precocious. The skill of the PU performer did not interfere with diagnostic accuracy. The presence of B-lines ≥ 15 correlated with high BNP values (≥ 500) and E/e' ratio ≥ 15, with prognostic impact in IC patients at hospital discharge and those followed up on an outpatient basis. In conclusion, when assessing pulmonary congestion in HF, PU has an incremental value in the diagnostic and prognostic approach in all scenarios studied.
No takes yet. Share an insight, caveat, or question.
Muniz et al. (2018) conducted a systematic review in Heart Failure. Pulmonary ultrasound vs. Physical examination and chest X-ray was evaluated on Diagnostic accuracy for pulmonary congestion. Pulmonary ultrasound achieved up to 90% diagnostic accuracy for pulmonary congestion in heart failure patients, outperforming standard physical examination and chest X-ray across multiple clinical settings.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: