Abstract 3589: Ultrasound Lung Comets for Differential Diagnosis of Dyspnea: Comparison With Plasma Cardiac Peptides
Background: Differentiating cardiac from non-cardiac causes of dyspnea, in patients admitted to the hospital with acute shortness of breath, is still a clinical challenge. Ultrasound lung comets (ULCs) are a simple, low-tech method for quantitative assessment of extra-vascular lung water, originating from water-thickened subpleural pulmonary interlobular septa.
Aim: To assess whether ULCs could help in differentiating cardiac from non-cardiac causes of acute dyspnea. Methods: We evaluated 98 patients (29 females; age 72±3 years) admitted with acute onset of dyspnea (NYHA class III or IV). Chest sonography and NT-proBNP assessment were performed on the same day (within 4 hours) in all patients and independently analyzed. ULCs were evaluated with transthoracic echography (2,5 MHz cardiac probe) on anterior chest at 28 pre-defined scanning sites. Two independent physicians, blinded to ULCs findings, reviewed all the medical records to establish the etiologic diagnosis of dyspnea.
Results: Cardiogenic dyspnea was confirmed in 82 patients, and ruled-out in 16 patients. ULCs number was significantly correlated to NT-proBNP values (r=49, p<001).With receiver operating characteristic (ROC) analysis, NT-proBNP values >098 pg/mL and ULCs number >5 had high, comparabl, and partially additive diagnostic accuracy to predict cardiogenic origin of dyspnea (see figure⇓).
Conclusions: In patients admitted with acute dyspnea, ULCs are a simple, highly feasible, effective tool to identify the cardiac origin of dyspnea through indirect imaging of extra-vascular lung water with chest sonography. Its diagnostic value may integrate the one provided by cardiac peptides.