title: Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study.
abstract: BACKGROUND
  Lung ultrasonography (LUS) has emerged as a noninvasive tool for the differential diagnosis of pulmonary diseases. However, its use for the diagnosis of acute decompensated heart failure (ADHF) still raises some concerns. We tested the hypothesis that an integrated approach implementing LUS with clinical assessment would have higher diagnostic accuracy than a standard workup in differentiating ADHF from noncardiogenic dyspnea in the ED.
  
  
  METHODS
  We conducted a multicenter, prospective cohort study in seven Italian EDs. For patients presenting with acute dyspnea, the emergency physician was asked to categorize the diagnosis as ADHF or noncardiogenic dyspnea after (1) the initial clinical assessment and (2) after performing LUS ("LUS-implemented" diagnosis). All patients also underwent chest radiography. After discharge, the cause of each patient's dyspnea was determined by independent review of the entire medical record. The diagnostic accuracy of the different approaches was then compared.
  
  
  RESULTS
  The study enrolled 1,005 patients. The LUS-implemented approach had a significantly higher accuracy (sensitivity, 97% [95% CI, 95%-98.3%]; specificity, 97.4% [95% CI, 95.7%-98.6%]) in differentiating ADHF from noncardiac causes of acute dyspnea than the initial clinical workup (sensitivity, 85.3% [95% CI, 81.8%-88.4%]; specificity, 90% [95% CI, 87.2%-92.4%]), chest radiography alone (sensitivity, 69.5% [95% CI, 65.1%-73.7%]; specificity, 82.1% [95% CI, 78.6%-85.2%]), and natriuretic peptides (sensitivity, 85% [95% CI, 80.3%-89%]; specificity, 61.7% [95% CI, 54.6%-68.3%]; n = 486). Net reclassification index of the LUS-implemented approach compared with standard workup was 19.1%.
  
  
  CONCLUSIONS
  The implementation of LUS with the clinical evaluation may improve accuracy of ADHF diagnosis in patients presenting to the ED.
  
  
  BACKGROUND
  Clinicaltrials.gov; No.: NCT01287429; URL: www.clinicaltrials.gov.
authors: Emanuele
authors: E
authors: Pivetta
authors: Alberto
authors: A
authors: Goffi
authors: Enrico
authors: E
authors: Lupia
authors: Maria
authors: M
authors: Tizzani
authors: Giulio
authors: G
authors: Porrino
authors: Enrico
authors: E
authors: Ferreri
authors: Giovanni
authors: G
authors: Volpicelli
authors: Paolo
authors: P
authors: Balzaretti
authors: Alessandra
authors: A
authors: Banderali
authors: Antonello
authors: A
authors: Iacobucci
authors: Stefania
authors: S
authors: Locatelli
authors: Giovanna
authors: G
authors: Casoli
authors: Michael B
authors: MB
authors: Stone
authors: Milena M
authors: MM
authors: Maule
authors: Ileana
authors: I
authors: Baldi
authors: Franco
authors: F
authors: Merletti
authors: Gian Alfonso
authors: GA
authors: Cibinel
authors: Paolo
authors: P
authors: Baron
authors: Stefania
authors: S
authors: Battista
authors: Giuseppina
authors: G
authors: Buonafede
authors: Valeria
authors: V
authors: Busso
authors: Andrea
authors: A
authors: Conterno
authors: Paola
authors: P
authors: Del Rizzo
authors: Patrizia
authors: P
authors: Ferrera
authors: Paolo Fascio
authors: PF
authors: Pecetto
authors: Corrado
authors: C
authors: Moiraghi
authors: Fulvio
authors: F
authors: Morello
authors: Fabio
authors: F
authors: Steri
authors: Giovannino
authors: G
authors: Ciccone
authors: Cosimo
authors: C
authors: Calasso
authors: Mimma A
authors: MA
authors: Caserta
authors: Marina
authors: M
authors: Civita
authors: Carmen
authors: C
authors: Condo'
authors: Vittorio
authors: V
authors: D'Alessandro
authors: Sara
authors: S
authors: Del Colle
authors: Stefania
authors: S
authors: Ferrero
authors: Giulietta
authors: G
authors: Griot
authors: Emanuela
authors: E
authors: Laurita
authors: Alberto
authors: A
authors: Lazzero
authors: Francesca
authors: F
authors: Lo Curto
authors: Marianna
authors: M
authors: Michelazzo
authors: Vincenza
authors: V
authors: Nicosia
authors: Nicola
authors: N
authors: Palmari
authors: Alberto
authors: A
authors: Ricchiardi
authors: Andrea
authors: A
authors: Rolfo
authors: Roberto
authors: R
authors: Rostagno
authors: Fabrizio
authors: F
authors: Bar
authors: Enrico
authors: E
authors: Boero
authors: Mauro
authors: M
authors: Frascisco
authors: Ilaria
authors: I
authors: Micossi
authors: Alessandro
authors: A
authors: Mussa
authors: Valerio
authors: V
authors: Stefanone
authors: Renzo
authors: R
authors: Agricola
authors: Gabriele
authors: G
authors: Cordero
authors: Federica
authors: F
authors: Corradi
authors: Cristina
authors: C
authors: Runzo
authors: Aldo
authors: A
authors: Soragna
authors: Daniela
authors: D
authors: Sciullo
authors: Domenico
authors: D
authors: Vercillo
authors: Attilio
authors: A
authors: Allione
authors: Nicoletta
authors: N
authors: Artana
authors: Fabrizio
authors: F
authors: Corsini
authors: Luca
authors: L
authors: Dutto
authors: Giuseppe
authors: G
authors: Lauria
authors: Teresa
authors: T
authors: Morgillo
authors: Bruno
authors: B
authors: Tartaglino
authors: Daniela
authors: D
authors: Bergandi
authors: Ilaria
authors: I
authors: Cassetta
authors: Clotilde
authors: C
authors: Masera
authors: Mario
authors: M
authors: Garrone
authors: Gianluca
authors: G
authors: Ghiselli
authors: Livia
authors: L
authors: Ausiello
authors: Letizia
authors: L
authors: Barutta
authors: Emanuele
authors: E
authors: Bernardi
authors: Alessia
authors: A
authors: Bono
authors: Daniela
authors: D
authors: Forno
authors: Alessandro
authors: A
authors: Lamorte
authors: Davide
authors: D
authors: Lison
authors: Bartolomeo
authors: B
authors: Lorenzati
authors: Elena
authors: E
authors: Maggio
authors: Ilaria
authors: I
authors: Masi
authors: Matteo
authors: M
authors: Maggiorotto
authors: Giulia
authors: G
authors: Novelli
authors: Francesco
authors: F
authors: Panero
authors: Massimo
authors: M
authors: Perotto
authors: Marco
authors: M
authors: Ravazzoli
authors: Elisa
authors: E
authors: Saglio
authors: Flavia
authors: F
authors: Soardo
authors: Alessandra
authors: A
authors: Tizzani
authors: Pietro
authors: P
authors: Tizzani
authors: Mattia
authors: M
authors: Tullio
authors: Marco
authors: M
authors: Ulla
authors: Elisa
authors: E
authors: Romagnoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015331:Cohort Studies; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000209:etiology*; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007558:Italy; D008171:Lung Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014463:Ultrasonography