Lung ultrasound can have greater sensitivity and equivalent specificity to chest x-ray for diagnosis of acute decompensated heart failure.

Overview

Lung ultrasound can be a reliable adjunct to existing diagnostic methods for acute decompensated heart failure both in the emergency department and other clinical settings, with greater sensitivity than chest x-ray and equivalent specificity.

A 2019 meta-analysis found a sensitivity of 88% and specificity of 90% for lung ultrasound for diagnosis of ADHF in patients presenting with dyspnea in all clinical settings, while a 2018 meta-analysis reports a sensitivity and specificity of 82.5% and 83.6%, respectively, for bedside lung ultrasound in patients presenting with dyspnea in emergency departments.

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Sensitivity and Specificity

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Publication

Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated Heart Failure: A Systematic Review and Meta-analysis.

Key Findings

Lung ultrasound for diagnosis of acute decompensated heart failure (ADHF):

• Sensitivity is 0.88 (95% Cl, 0.75-0.95)
• Specificity is 0.90 (95% Cl, 0.88-0.92)

Chest x-ray for diagnosis of ADHF:

• Sensitivity is 0.73 (95% CI, 0.70-0.76)
• Specificity is 0.90 (95% CI, 0.75-0.97)

Relative ratio of lung ultrasound to chest x-ray:

• Relative sensitivity ratio is 1.2 (95% CI, 1.08-1.34; P < .001)
• Relative specificity ratio was not significantly different (1.0; 95% CI, 0.90-1.11; P = .96)

Paper Implications

• Lung ultrasound has greater sensitivity than chest x-ray for ADHF detection
• Lung ultrasound can be used to support diagnosis of ADHF in patients with dyspnea in all clinical settings

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Publication

Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: a systematic review and meta-analysis.

Key Findings

Bedside lung ultrasound for diagnosis of acute decompensated heart failure (ADHF):

• Sensitivity is 82.5% (95% CI = 66.4% to 91.8%)
• Specificity is 83.6% (95% CI=72.4% to 90.8%)

Paper Implications

• In emergency departments, B-lines in bedside lung ultrasound can be reliably used as adjunct to current diagnostic methods in patients presenting with undifferentiated dyspnea