tailieunhanh - Báo cáo y học: "Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting. | Prosen et al. Critical Care 2011 15 R114 http content 15 2 R114 KS CRITICAL CARE RESEARCH Open Access Combination of lung ultrasound a comet-tail sign and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting Gregor Prosen1 2 Petra Klemen1 2 3 Matej Strnad1 2 and Stefek Grmec1 2 3 4 Abstract Introduction We studied the diagnostic accuracy of bedside lung ultrasound the presence of a comet-tail sign N-terminal pro-brain natriuretic peptide NT-proBNP and clinical assessment according to the modified Boston criteria in differentiating heart failure HF -related acute dyspnea from pulmonary chronic obstructive pulmonary disease COPD asthma -related acute dyspnea in the prehospital setting. Methods Our prospective study was performed at the Center for Emergency Medicine Maribor Slovenia between July 2007 and April 2010. Two groups of patients were compared a HF-related acute dyspnea group n 129 and a pulmonary asthma COPD -related acute dyspnea group n 89 . All patients underwent lung ultrasound examinations along with basic laboratory testing rapid NT-proBNP testing and chest X-rays. Results The ultrasound comet-tail sign has 100 sensitivity 95 specificity 100 negative predictive value NPV and 96 positive predictive value PPV for the diagnosis of HF. NT-proBNP cutoff point 1 000 pg mL has 92 sensitivity 89 specificity 86 NPV and 90 PPV. The Boston modified criteria have 85 sensitivity 86 specificity 80 NPV and 90 PPV. In comparing the three methods we found significant differences between ultrasound sign and 1 NT-proBNP P and 2 Boston modified criteria P . The combination of ultrasound sign and NT-proBNP has 100 sensitivity 100 specificity 100 NPV and 100 PPV. With the use of ultrasound we can exclude HF in patients with pulmonary-related dyspnea who have positive NT-proBNP 1 000 pg mL and a history of HF. .