title: Diagnostic accuracy of emergency Doppler echocardiography for identification of acute left ventricular heart failure in patients with acute dyspnea: comparison with Boston criteria and N-terminal prohormone brain natriuretic peptide.
abstract: OBJECTIVE
  Echocardiography is a fundamental tool in the diagnosis of acute left ventricular heart failure (aLVHF). However, a consultative exam is not routinely available in every emergency department (ED). The authors investigated the diagnostic performance of emergency Doppler echocardiography (EDecho) performed by emergency physicians (EPs) for the diagnosis of aLVHF in patients with acute dyspnea.
  
  
  METHODS
  A convenience sample of acute dyspneic patients was evaluated. For each patient, the Boston criteria score for heart failure was calculated, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) and EDecho were contemporaneously performed. Four investigators, after a limited echocardiography course, performed EDechos and evaluated for a "restrictive" pattern on pulsed Doppler analysis of mitral inflow and reduced left ventricular (LV) ejection fraction. The final diagnosis, established after reviewing all patient clinical data except NT-proBNP and EDecho results, served as the criterion standard.
  
  
  RESULTS
  Among 145 patients, 64 (44%) were diagnosed with aLVHF. The median time needed to perform EDecho was 4 minutes. Pulsed Doppler analysis was feasible in 125 patients (84%). The restrictive pattern was more sensitive (82%) and specific (90%) than reduced LV ejection fraction and more specific than the Boston criteria and NT-proBNP for the diagnosis of aLVHF. Considering noninterpretable values of the restrictive pattern and uncertain values ("gray areas") of Boston criteria (4 < Boston criteria score < 7) and of NT-proBNP (300 < NT-proBNP < 2,200 pg/mL) as false results, the accuracy of the restrictive pattern in the overall population was 75%, compared with accuracy of 49% for both NT-proBNP and Boston criteria.
  
  
  CONCLUSIONS
  EDecho, particularly pulsed Doppler analysis of mitral inflow, is a rapid and accurate diagnostic tool in the evaluation of patients with acute dyspnea.
authors.affiliation: Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. pnazerian@hotmail.com
authors.forename: Peiman
authors.initials: P
authors.lastname: Nazerian
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zanobetti
authors.forename: Gianluca
authors.initials: G
authors.lastname: Polidori
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pepe
authors.forename: Roberto
authors.initials: R
authors.lastname: Federico
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cangioli
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000209:etiology; D015150:Echocardiography, Doppler / Q000379:methods / Q000592:standards*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006785:Hospitals, University; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D010446:Peptide Fragments; D020097:Natriuretic Peptide, Brain