A systematic review of 10 studies found limited evidence for markers diagnosing acute heart failure in dyspneic COPD patients, though BNPs and inspiratory IVC diameter showed the highest discrimination.
Systematic Review
Do diagnostic markers accurately identify acute heart failure in acutely dyspneic patients with COPD presenting at the hospital?
There is currently insufficient high-quality evidence to support the routine use of specific markers for diagnosing acute heart failure in dyspneic COPD patients, though natriuretic peptides and IVC ultrasound show promise.
Background: Due to shared symptoms, acute heart failure (AHF) is difficult to differentiate from an acute exacerbation of COPD (AECOPD). This systematic review aimed to identify markers that can diagnose AHF underlying acute dyspnea in patients with COPD presenting at the hospital. Methods: All types of observational studies and clinical trials that investigated any marker's ability to diagnose AHF in acutely dyspneic COPD patients were considered eligible for inclusion. An AI tool (ASReview) supported the title and abstract screening of the articles obtained from PubMed, Scopus, Web of Science, the Cochrane Library, Embase, and CINAHL until April 2023. Full text screening was independently performed by two reviewers. Twenty percent of the data extraction was checked by a second reviewer and the risk of bias was assessed in duplicate using the QUADAS-2 tool. Markers' discriminative abilities were evaluated in terms of sensitivity, specificity, positive and negative predictive values, and the area under the curve when available. Results: The search identified 10,366 articles. After deduplication, title and abstract screening was performed on 5,386 articles, leaving 153 relevant, of which 82 could be screened full text. Ten distinct studies (reported in 16 articles) were included, of which 9 had a high risk of bias. Overall, these studies evaluated 12 distinct laboratory and 7 non-laboratory markers. BNP, NT-proBNP, MR-proANP, and inspiratory inferior vena cava diameter showed the highest diagnostic discrimination. Conclusion: There is not much evidence for the use of markers to diagnose AHF in acutely dyspneic COPD patients in the hospital setting. BNPs seem most promising, but should be interpreted alongside imaging and clinical signs, as this may lead to improved diagnostic accuracy. Future validation studies are urgently needed before any AHF marker can be incorporated into treatment decision-making algorithms for patients with COPD. Protocol Registration: CRD42022283952.
Dijk et al. (Thu,) conducted a systematic review in Acute heart failure in patients with COPD. Diagnostic markers (including BNP, NT-proBNP, MR-proANP, and inspiratory inferior vena cava diameter) was evaluated on Diagnostic discrimination (sensitivity, specificity, positive and negative predictive values, and area under the curve). A systematic review of 10 studies found limited evidence for markers diagnosing acute heart failure in dyspneic COPD patients, though BNPs and inspiratory IVC diameter showed the highest discrimination.