Key result
IVC ultrasound shows suboptimal accuracy with ~0.72 AUC for acute heart failure in emergency dyspnea.
Why the study?
Rapid and accurate differentiation between acute heart failure and pulmonary causes of acute dyspnea in the emergency department is critical but challenging.
Observational (n=155)
Yes
Caution against relying on IVC sonography alone for acute dyspnea in the ED; leaves open validation of superior multimodal diagnostics.
Acute dyspnea is one of the main reasons for admission to the Emergency Department (ED). A rapid and accurate diagnosis can be lifesaving for these patients. Particularly, it is important to differentiate between dyspnea due to acute heart failure (AHF) and dyspnea of pulmonary origin. The aim of this study is to evaluate the real accuracy of the evaluation of diameter and collapsibility of IVC for the diagnosis of AHF among dyspneic patients. We analyzed 155 patients admitted for acute dyspnea to the ED of "Maurizio Bufalini" hospital in Cesena (Italy) and "Antonio Cardarelli" hospital in Naples (Italy) from November 2014 to April 2017. All patients underwent ultrasound of inferior vena cava (IVC) examination with a hand-held device in addition to the traditional pathway. Patients were classified into AHF group or non-AHF group according to the current guidelines. The final diagnosis was AHF in 64 patients and dyspnea of non-cardiac origin in 91 patients. Sensibility and specificity of IVC hypo-collapsibility was 75.81% (95% CI 63.26% to 85.78%) and 67.74% (95% CI 57.25% to 77.07%) for the diagnosis of AHF. Sensibility and specificity of IVC dilatation was 69.35% (95% CI 56.35% to 80.44%) and 74.19% (95%CI 64.08% to 82.71%) for the diagnosis of AHF. AUC was 0.718 (0.635-0.801) for IVC hypo-collapsibility, 0.718 (0.634-0.802) for IVC dilatation. Our study demonstrated that the sonographic assessment of IVC diameter and collapsibility is suboptimal to differentiate acute dyspnea due to AHF or other causes in the emergency setting.
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Sforza et al. (2020) conducted an observational in Acute dyspnea / Acute heart failure (n=155). Sonographic evaluation of inferior vena cava (IVC) hypo-collapsibility and dilatation vs. Final clinical diagnosis by independent observers (gold standard) was evaluated on Diagnostic accuracy (Area Under the Curve) of IVC hypo-collapsibility for acute heart failure (AUC 0.718, 95% CI 0.635-0.801). Sonographic evaluation of inferior vena cava hypo-collapsibility and dilatation demonstrated suboptimal diagnostic accuracy (AUC 0.718 for both) for differentiating acute heart failure from other causes of acute dyspnea in the emergency setting.
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