Point-of-care chest ultrasound to diagnose acute heart failure in emergency department patients with acute dyspnea: diagnostic performance of an ultrasound-based algorithm.

Candice Vauthier (1, 2) , Margaux Chabannon (1, 2) , Thibaut Markarian (3, 4) , Yann Taillandy (1, 2) , Kevin Guillemet (1, 2) , Hugo Krebs (1, 2) , Florian Bazalgette (1, 2) , Laurent Muller (5, 2) , Pierre-Géraud Claret (1, 6) , Xavier Bobbia (1, 6)

1 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
2 UM - Université de Montpellier
3 Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM]
4 AMU - Aix Marseille Université
5 CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes]
6 IMAGINE - Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts

Objectives: Cardiopulmonary ultrasound imaging can be useful for diagnosing acute heart failure (AHF). We aimed to evaluate the diagnostic performance of an algorithm based on point-of-care ultrasound (POCUS) in patients coming to the emergency department with acute dyspnea. Material and methods: Prospective analysis of a convenience sample of patients with acute dyspnea in 2 hospital emergency departments. The POCUS algorithm included lung ultrasound findings and 3 echocardiographic measurements taken from an apical view of 4 chambers: mitral annular plane systolic excursion, Doppler mitral flow velocity, and tissue Doppler imaging of the lateral mitral annulus. The definitive diagnosis was made by 2 physicians blinded to the POCUS findings. Results: A total of 103 adult patients with a mean (SD) age of 73 (12) years were included; about half (51 patients) were women. Forty-two patients (41%) were finally diagnosed with AHF. Interindividual agreement on the physicians' diagnoses was good (k = 0.82). The POCUS algorithm assigned an AHF diagnosis to 76 patients (74%); 56 of them (85%) were in sinus rhythm. The diagnostic performance indicators for the algorithm were as follows: area under the receiver operating characteristic curve, 0.94 (95% CI, 0.88-1.00); sensitivity 96% (95% CI, 78%-100%); specificity, 93% (95% CI, 8%-98%); positive predictive value, 85% (95% CI, 67%-100%); negative predictive value, 98% (95% CI, 88%-100%). Conclusion: The POCUS-based algorithm for diagnosing AHF performed well in patients coming to the emergency department with acute dyspnea.

Trial registration: ClinicalTrials.gov NCT04327882.

Mots clés: Sistemas de atención de salud.; Acute heart failure.; Disnea.; Dyspnea.; Emergency medicine.; Health care systems.; Insuficiencia cardiaca aguda.; Medicina de urgencias.; Ultrasonido.; Ultrasonography.

Domaines: Médecine humaine et pathologie

Candice Vauthier, Margaux Chabannon, Thibaut Markarian, Yann Taillandy, Kevin Guillemet, et al.. Point-of-care chest ultrasound to diagnose acute heart failure in emergency department patients with acute dyspnea: diagnostic performance of an ultrasound-based algorithm.. Emergencias : Revista de La Sociedad Espanola de Medicina de Emergencias, 2021, 33 (6), pp.441-446. ⟨hal-03621335⟩