Why the study?
Both BNP assay and Doppler echocardiography are relevant diagnostic tests for heart failure, but their comparative accuracy for diagnosing decompensated CHF in acute dyspnea was unclear.
Does a standardized lung ultrasound protocol performed by a non-expert operator accurately diagnose the etiology of acute dyspnea and predict adverse outcomes in emergency department patients?
Observational (n=163)
Final diagnoses were established by physicians who were blinded to the BNP and Doppler findings
Does a standardized lung ultrasound protocol performed by a non-expert operator accurately diagnose the etiology of acute dyspnea and predict adverse outcomes in emergency department patients?
Lung ultrasound performed by minimally trained non-expert operators using a standardized protocol can rapidly and accurately identify the cause of acute dyspnea, such as heart failure, while effectively predicting short-term adverse outcomes.
OBJECTIVES: We compared the accuracy of B-type natriuretic peptide (BNP) assay with Doppler echocardiography for the diagnosis of decompensated congestive left-heart failure (CHF) in patients with acute dyspnea. BACKGROUND: Both BNP and Doppler echocardiography have been described as relevant diagnostic tests for heart failure. METHODS: One hundred sixty-three consecutive patients with severe dyspnea underwent BNP assay and Doppler echocardiogram on admission. The accuracy of the two methods for etiologic diagnosis was compared on the basis of the final diagnoses established by physicians who were blinded to the BNP and Doppler findings. RESULTS: The final etiologic diagnosis was CHF in 115 patients. Twenty-four patients (15%) were misdiagnosed at admission. The BNP concentration was 1,022 +/- 742 pg/ml in the CHF subgroup and 187 +/- 158 pg/ml in the other patients (p < 0.01). A BNP cutoff of 300 pg/ml correctly classified 88% of the patients (odds ratio [OR] 85 [19 to 376], p < 0.0001), but a high negative predictive value (90%) was only obtained when the cutoff was lowered to 80 pg/ml. The etiologic value of BNP was low in patients with values between 80 and 300 pg/ml (OR 1.85 [0.4 to 7.8], p = 0.4) and also in patients who were studied very soon after onset of acute dyspnea. Among the 138 patients with assessable Doppler findings, a "restrictive" mitral inflow pattern had a diagnostic accuracy for CHF of 91% (OR 482 [77 to 3,011], p < 0.0001), regardless of the BNP level. CONCLUSIONS: Bedside BNP measurement and Doppler echocardiography are both useful for establishing the cause of acute dyspnea. However, Doppler analysis of the mitral inflow pattern was more accurate, particularly in patients with intermediate BNP levels or "flash" pulmonary edema.
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Logeart et al. (2002) conducted an observational in Acute dyspnea / Decompensated congestive left-heart failure (n=163). Doppler echocardiography (restrictive mitral inflow pattern) vs. B-type natriuretic peptide (BNP) assay was evaluated on Diagnostic accuracy for congestive heart failure (CHF) (OR 482, 95% CI 77-3011, p=<0.0001).
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