Accuracy of chest radiographs in the emergency diagnosis of heart failure.
The purpose of this study was to determine the diagnostic accuracy of chest radiographic findings of heart failure (HF) in current patients presenting with dyspnea in the emergency department. In a secondary analysis of the BASEL study, initial chest radiographs of 277 patients with acute dyspnea were evaluated by two radiologists blinded to the adjudicated diagnosis (56% had the final diagnosis of HF). Predefined radiographic criteria of HF were used. Statistical analysis included receiver-operating characteristic (ROC) analysis and calculation of a logistic regression model including B-type natriuretic peptide (BNP) levels. The reader's overall impression showed the highest area under the ROC curve for the diagnosis of HF in both supine and erect patient positions (0.855 and 0.857). Among individual radiographic findings, peribronchial cuffing in the supine position (0.829) showed the highest accuracies. The lowest accuracy was found for the vascular pedicle width in the supine position (0.461). Logistic regression analysis showed no significant differences between the reader's overall impression, the radiographic model, and BNP testing. In our study, the combination of radiographic features provided valuable information and was of comparable accuracy as BNP-testing for the diagnosis of HF.
Studler
Ueli
U
Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. studleru@uhbs.ch
Kretzschmar
Martin
M
Christ
Michael
M
Breidthardt
Tobias
T
Noveanu
Markus
M
Schoetzau
Andreas
A
Perruchoud
André P
AP
Steinbrich
Wolfgang
W
Mueller
Christian
C
D000208:Acute Disease; D000368:Aged; D004417:Dyspnea / Q000150:complications* / Q000000981:diagnostic imaging*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015995:Prevalence; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013557:Switzerland / Q000453:epidemiology