Assessment of left atrial size in addition to focused cardiopulmonary ultrasound improves diagnostic accuracy of acute heart failure in the Emergency Department

BackgroundAcute dyspnea is one of the main reasons for admission to Emergency Department (ED). Availability of ultraminiaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. The aim of this study was to identify an integrated ultrasound approach for diagnosis of acute heart failure (acute HF), using PUD and combining evaluation from lung, heart and inferior vena cava (IVC). MethodsWe included 102 patients presenting to the ED of Antonio Cardarelli Hospital in Naples (Italy) for acute dyspnea (AD). All patients underwent integrated ultrasound examination (IUE) of lung-heart-IVC, using PUD. The gold standard was the final diagnosis determined by two expert reviewers: acute heart failure (acute HF) or noncardiac dyspnea. We used 2x2 contingency tables to analyze sensitivity, specificity, positive and negative predictive value and accuracy of the three ultrasonic methods, and their combinations for the diagnosis of acute HF, comparing with the final, validated diagnosis. ResultsLung ultrasound (LUS) alone exhibited a good sensitivity (100%) and specificity (82%) and had the highest accuracy (89%) among single modalities (heart and IVC) for the diagnosis of acute HF. The highest accuracy among all methods (96%) was obtained by the combination of positive LUS and either dilated left atrium or EF40% or both (all P<.01 vs single modalities). ConclusionIn patients presenting to ED, IUE using PUD is a useful extension of clinical examination and has a reliable diagnostic discriminant ability in the immediate evaluation of acute dyspnea. The combination of positive LUS with focused cardiac ultrasonography (FoCUS), including also dilated left atrium, substantially extends the spectrum of recognizable acute HF.