© 2008 European Society of Cardiology
Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: A comparison with natriuretic peptides
a Institute of Clinical Physiology, National Research Council Pisa, Italy
b Hospital "Valle del Serchio", Castelnuovo Garfagnana Lucca, Italy
c Clinica "Montevergine" Mercogliano, Avellino, Italy
d Division of Cardiology, Feinberg School of Medicine, Northwestern University Chicago, IL, USA
* Corresponding author. CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124, Pisa, Italy. Tel.: +39 050 3152399; fax: +39 050 3152216. E-mail address: gargani{at}ifc.cnr.it (L. Gargani).
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Abstract |
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Background: Acute dyspnoea as a presenting symptom is a frequent diagnostic challenge for physicians. The main differential diagnosis is between dyspnoea of cardiac and non-cardiac origin. Natriuretic peptides have been shown to be useful in this setting. Ultrasound lung comets (ULCs) are a simple, echographic method which can be used to assess pulmonary congestion.
Aim: To evaluate the accuracy of ULCs for predicting dyspnoea of cardiac origin compared to natriuretic peptides.
Methods: We evaluated 149 patients admitted with acute dyspnoea. Chest sonography and NT-proBNP assessments were performed a maximum of 4 h apart and independently analyzed. ULCs were evaluated via cardiac probes placed on the anterior and lateral chest. Two independent physicians, blinded to ULCs and NT-proBNP findings, reviewed all the medical records to establish the aetiologic diagnosis of dyspnoea.
Results: Cardiogenic dyspnoea was confirmed in 122 patients and ruled-out in 27 patients. The number of ULCs was significantly correlated to NT-proBNP values (r=.69, p<.0001). Receiver operating characteristic analysis, showed an area under the curve of .893 for ULCs and .978 (p=.001) for NT-proBNP, in predicting the cardiac origin of dyspnoea.
Conclusions: In patients admitted with acute dyspnoea, pulmonary congestion, sonographically imaged as ULCs, is significantly correlated to NT-proBNP values. The accuracy of ULCs in predicting the cardiac origin of dyspnoea is high.
Key Words: Ultrasound lung comets • NT-proBNP • Differential diagnosis of dyspnoea
Received March 26, 2007; Revised August 14, 2007; Accepted October 18, 2007
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