Diagnostic accuracy of lung ultrasound for identification of elevated left ventricular filling pressure

被引:38
作者
Hubert, Arnaud [1 ,2 ,3 ,4 ]
Girerd, Nicolas [5 ,6 ]
Le Breton, Herve [1 ,2 ,3 ,4 ]
Galli, Elena [1 ,2 ,3 ,4 ]
Latar, Ichraq [5 ,6 ]
Fournet, Maxime [1 ,2 ,3 ,4 ]
Mabo, Philippe [1 ,2 ,3 ,4 ]
Schnell, Frederic [1 ,2 ,3 ,7 ]
Leclercq, Christophe [1 ,2 ,3 ,4 ]
Donal, Erwan [1 ,2 ,3 ,4 ]
机构
[1] CHU Rennes, Serv Cardiol & Malad Vasc, 2 Rue Henri Le Guilloux, F-35000 Rennes, France
[2] CHU Rennes, CIC IT 1414, F-35000 Rennes, France
[3] Univ Rennes 1, LTSI, F-35000 Rennes, France
[4] INSERM, UI099, F-35000 Rennes, France
[5] Univ Lorraine, CHU Nancy, Inst Lorrain Coeur & Vaisseaux, Ctr Invest Clin 1433,INSERM, Nancy, France
[6] INI CRCT Cardiovasc & Renal Clin Trialists F CRIN, Nancy, France
[7] CHU Rennes, Serv Med Sport, F-35000 Rennes, France
关键词
B-lines; Lung ultrasonography; Left vermicular filling pressure; Echocardiography; HEART-FAILURE; PULMONARY CONGESTION; PROGNOSTIC VALUE; ECHOCARDIOGRAPHIC INDEXES; PREDICTS DECOMPENSATION; EUROPEAN ASSOCIATION; DIASTOLIC FUNCTION; AMERICAN SOCIETY; COMETS; RECOMMENDATIONS;
D O I
10.1016/j.ijcard.2019.01.055
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: The current algorithm in transthoracic echocardiography (TTE) proposed in the 2016 ASE EACVI recommendation for the estimation of left ventricular filling pressure (LVFP) is quite complex and time-consuming. B-lines, in lung ultrasonography ( LUS), could constitute an interesting tool for LVFP evaluation in clinical practice, although data regarding their association with invasive haemodynamics are lacking. The purpose of this study was to explore the diagnostic accuracy of B-lines in identifying elevated left ventricular end-diastolic pressure (LVEDP). Method and results: 31 adults with significant dyspnoea (NYHA 2) were prospectively analyzed by LUS in four areas in each hemithorax and a complete TTE within four hours prior to coronary angiography. Twenty-eight patients had elevated LVEDP. Clinical variables yielded a C-index of 79% to identify elevated LVEDP. The number of total B-lines was higher in the elevated LVEDP group (1.0vs17.0, p < 0.0001) and significantly increased the diagnostic accuracy (C-index increase 10.5%, p 0.002) and net reclassification index (NRI 145.4, 113.0177.9, p < 0.0001) on top of clinical variables. Conclusion: This study demonstrates the substantial iagnostic capacity of B-lines to identify elevated LVEDP, which appears superior to that of classical echocardiographic strategies. This tool should be considered in a multi-parametric approach in patients with heart failure. (C) 2019 Elsevier B.V. All rights reserved.
引用
收藏
页码:62 / 68
页数:7
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