Echo best test for acute LVF in ED

March 18, 2010 by  
Filed under Acute Med, All Updates, Ultrasound

Three diagnostic tests for acute left ventricular heart failure in dyspnoeic patients were compared, with the gold standard being the diagnosis by three independent reviewers (two cardiologists and one respiratory physician) who were blinded to the results of the tests being examined. The tests in question were  NT-proBNP, the Boston criteria, and limited echo performed by emergency physicians.

The primary goal of the echo study was the detection of the following echocardiographic variables, expressed as present or absent: reduced LV ejection fraction (LV ejection fraction <50% on subjective visual estimation of the change in LV size between diastole and systole) and the ‘‘restrictive’’ pattern on pulsed Doppler analysis of mitral inflow (using the apical view).

According to the authors, pulsed Doppler analysis of mitral inflow can be described by three patterns: 1) an ‘‘impaired relaxation’’ pattern, suggesting no increase in LV filling pressures; 2) a ‘‘normal’’ or ‘‘normalized’’ pattern; and 3) a restrictive pattern, suggesting an increase in LV filling pressures.

Trained emergency physicians were able to perform EDecho in a median of 4 minutes, obtaining Doppler data in an average of 80% of patients presenting for acute dyspnea. Considering the 125 patients with both EDecho variables available, reduced LV ejection fraction was less accurate than the restrictive mitral pattern for the diagnosis of aLVHF. The restrictive pattern was more sensitive (82%) and specific (90%) than reduced LV ejection fraction and more specific than the Boston criteria and NT-proBNP for the diagnosis of aLVHF. The accuracy of the restrictive pattern in the overall population was 75%, compared with accuracy of 49% for both NT-proBNP and Boston criteria.

Diagnostic accuracy of emergency Doppler echocardiography for identification of acute left ventricular heart failure in patients with acute dyspnea: comparison with Boston criteria and N-terminal prohormone brain natriuretic peptide.
Acad Emerg Med. 2010 Jan;17(1):18-26

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