Application Of Cardiopulmonary Ultrasound In Patients With Dyspnea

Objective: Ultrasound lung comets(ULCs),known as B-lines,are a non-radiologic and invasive bedside approach to assess extravascular lung water in patients with heart failure.However,there is no defined method for grading the severity of signs that are typical on lung ultrasound in clinic.We evaluated a protocol for grading ULC score to estimate pulmonary congestion in heart failure patients in emergency department and intensive care unit,and investigated clinical and echocardiographic correlates of the ULC score.Methods: Ninety-three dyspenic patients with congestive heart failure,admitted to the emergency department or intensive care unit underwent transthoracic pulmonary ultrasound and echocardiography.A ULC score was obtained by summing the ULC scores of 7 zones of anterolateral chest scans.The results of ULC score were compared with echocardiographic results,the New York Heart Association(NYHA)functional classification,radiologic score,and NT-pro BNP.Results: Positive linear correlations were found between the 7-zone ULC score and the following: E/e′,systolic pulmonary artery pressure,severity of mitral regurgitation,left ventricular global longitudinal strain,NYHA functional classification,radiologic score,and NT-pro BNP.However,there was no significant correlation between ULC score and left ventricular ejection fraction,left ventricle diameter,left ventricular volume,or left atrial volume.A multivariate analysis identified the E/e′,systolic pulmonary artery pressure and radiologic score as the only independent variables associated with ULC score increase.Conclusion: Grading ULC score is a rapid and noninvasive method to assess lung congestion.Diastolic rather than systolic performance may be the most important determinant of the degree of lung congestion in patients with heart failure.Objective: Detection of multiple B-lines is common on transthoracic ultrasonography(TUS)in dyspneic patients in Emergency Department(ED)and Intensive Care Unit(ICU).Previous studies on the etiological diagnosis for dyspnea according to the presence or absence of the B lines,the distribution of B-lines(limited or distributed),unilateral or bilateral B-lines distribution and so on,and the correlation between different distance of B-lines and chest CT signs.However,several existing literatures on the depiction of the pleural line are confined to the subpopulation with interstitial lung disease.We have found that multiple B-lines are often accompanied by abnormal changes of pleural line on TUS in practice.The aim of the study was to evaluate the relevance and diagnostic performance of pleural line abnormalities and multiple B-lines detected on high-resolution TUS against the chest computed tomography(CT)findings.Methods: TUS was performed in patients admitted to the emergency department and intensive care unit with dyspnea.The pleural line and accompanying B-lines were assessed using a high-frequency linear transducer.TUS findings were assessed against the corresponding high-resolution CT findings in the same location,which were considered to be the gold standard.Sensitivity,specificity,and positive/negative predictive values were obtained.Results: Out of a total of 116 patients,68.1% had changes of the pleural line on TUS.The characteristic changes of the pleural line were classified into four types: Slightly rough pleural line with confluent B-lines on TUS corresponded with CT findings of ground-glass opacity.Irregular and interrupted pleural line with confluent B-lines corresponded with parenchymal infiltration.Fringed pleural line with confluent B-lines corresponded with superimposed ground-glass and irregular reticular opacities,and fringed pleural line with scattered B-lines corresponded with irregularly thickened interlobular septa.Wavy pleural line indicated sub-pleural emphysema.The coexistence of abnormal pleural line was also found in 31 cases(26.7%).Conclusion: High-resolution TUS may help in the initial assessment of lung pathology by its ability to identify pleural line abnormalities and B-lines that were shown to be associated with chest CT,which could add diagnostic value in the emergency evaluation of dyspneic patients.Objective: Echocardiography is a commonly used diagnostic tool in emergency department and intensive care unit in patients with dyspnea.For differential diagnosis of cardiogenic and pulmonary dyspnea,echocardiography can quickly and accurately obtain information on cardiac function and structure,and provide the basic diagnostic information for primary diagnosis.Studies showed that about 1/3 of patients with dyspnea in emergency department had abnormal right ventricular system,the need for further examination of the etiology when pulmonary hypertension was observed by echocardiography.In recent years,the development and application of pulmonary ultrasound has opened the door for rapid etiological diagnosis for those patients.The aim of this study was to investigate the value of lung ultrasound in screening the etiology of pulmonary hypertension detected by bedside echocardiography in dyspneic patients.Methods: Bedside echocardiography was ordered to the intensive care unit and emergency department in 322 consecutive dyspneic patients.The three steps to check: first,phased array transducer was used to evaluate heart;followed by the same transducer for preliminary lung examination;then linear transducer was used to explore the shape of pleural line and sub-pleural alteration.The criteria for the diagnosis of pulmonary ultrasound are as follows: massive pleural effusion with lung compression represented pulmonary atelectasis;Consolidation with shredded boundary represented pneumonia;Sub-pleural consolidation with wedge-shape(with the vertex towards the hilum)or small rounded consolidation represented pulmonary embolism;Multiple B-lines with Smooth pleural line,slightly rough and/or irregular and interrupted pleural line,fringed pleural line represented cartographic pulmonary edema,pneumonia and interstitial fibrosis,respectively.Results: Pulmonary hypertension was detected in 107 cases(33.2%),COPD and pulmonary embolism were most common in negative group of lung ultrasound.In positive group of lung ultrasound,pneumonia was the most common etiology,others are cardiogenic pulmonary edema,pulmonary interstitial fibrosis,pleural effusion and pulmonary atelectasis,pulmonary embolism.In addition,various diagnostic signs of lung ultrasonography were detected in 15 cases.Echocardiography showed that there were different degrees of right ventricular enlargement in patients with pulmonary embolism and chronic obstructive pulmonary disease;In cardiogenic pulmonary edema group,7 cases(24.1%)showed right ventricular enlargement;16 cases(55.1%)in the pneumonia group showed right ventricular enlargement;In the interstitial fibrosis group,9 cases(45%)showed right ventricular enlargement;3 cases(42.9%)in the pleural effusion and atelectasis group showed right ventricular enlargement.Conclusions: Further examination by lung ultrasound after detection of pulmonary hypertension by echocardiography can provide possible etiological diagnosis.