Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the Emergency Department - A SIMEU multicenter study.

BACKGROUND.: Lung ultrasonography (LUS) has recently emerged as a non-invasive tool for the differential diagnosis of pulmonary diseases. However, its use for the diagnosis of acute decompensated heart failure (ADHF) still raises some concerns. Here, we tested the hypothesis that an integrated approach implementing LUS with the clinical assessment would have higher diagnostic accuracy than standard work-up in differentiating ADHF from non-cardiogenic dyspnea in the Emergency Department (ED). METHODS.: We conducted a multicenter prospective cohort study in seven Italian EDs. For patients presenting with acute dyspnea, the emergency physician was asked to categorize the diagnosis as ADHF or non-cardiogenic dyspnea a) after the initial clinical assessment, and b) after performing LUS ("LUS-implemented" diagnosis). All patients also underwent chest radiography. After discharge, the cause of patient's dyspnea was determined by independent review of the entire medical records. The diagnostic accuracy of the different approaches was then compared. RESULTS.: One-thousand-five patients were enrolled. The LUS-implemented approach had a significantly higher accuracy (sensitivity 97%; 95% CI, 95-98.3%; specificity 97.4%; 95% CI 95.7-98.6%) in differentiating ADHF from non-cardiac causes of acute dyspnea than the initial clinical work-up (sensitivity 85.3%; 95% CI, 81.8-88.4%; specificity 90%; 95% CI, 87.2-92.4%), chest radiography alone (sensitivity 69.5%; 95% CI, 65.1-73.7%; specificity 82.1%; 95% CI, 78.6-85.2%), and natriuretic peptides (sensitivity 85%; 95% CI, 80.3-89%; specificity 61.7%; 95% CI, 54.6-68.3%; No.=486 patients). Net reclassification index of LUS-implemented approach compared to standard work-up was 19.1%. CONCLUSIONS.: The implementation of LUS with the clinical evaluation may improve accuracy of ADHF diagnosis in patients presenting to the ED. CLINICAL TRIAL REGISTRATION.: ClinicalTrials.gov number, NCT01287429 (http://clinicaltrials.gov/show/NCT01287429)