| Objective:By observing the performance of lung ultrasound(LUS)and cardiac ultrasound in patients with heart failure,analyse the relationship among B line score of LUS,echocardiographic parameters and Plasma NT-pro BNP concentration assess the clinical value of B line score combined with echocardiographic parameters in evaluating the heart failure.Methods:From January 2016 to December 2016,96 patients with suspected heart failure who were hospitalized in the Department of Cardiology of the Second Hospital of Jilin University were selected as the observation group.The inclusion criteria included a history of chronic or sudden cardiovascular disease,or limitation of activity tolerance,breathing difficulties and other symptoms of heart failure.Patients with non vascular disease and symptoms in the same period were selected as control group.Patients with lung disease,chronic kidney disease,liver cirrhosis,hemodialysis,recent heart surgery,or thoracic deformity,breast prosthesis cannot scanned by LUS and incomplete observation of patients were all excluded in observation and control group.The patients in the observation group were diagnosed with heart failure according to the Framingham standard,75 patients with heart failure and 21 patients non heart failure.According to the New York heart disease association classification(NYHA classification)standard,divided into 20 cases of grade II,24 cases of grade III,31 cases of grade IV.All patients were examined by echocardiography and lung ultrasound within 24 hours of admission.Patients were examined by echocardiography on left lateral resting state.The echocardiographic parameters include LAD,LVEDD,LVEF,E/Ea and MRA were measured.The patients take supine or semisupine position,according to the 2012 international lung ultrasound guidelines recommend volpicelli eight partition method for lung ultrasound [1].The number of B lines between the anterior chest wall and the lateralchest wall was observed,and the largest number of B lines in each region was stored for off line analysis.Finally,the total number of B lines in the eight area was used as the B line score.At the same time,the clinical data,physical examination,electrocardiogram,chest X-ray and plasma NT-pro BNP concentration were recorded Statistical analysis and processing of the data were performed by spss21.0 statistical software,P<0.05 believes that there was statistically significant difference.Results:1.There was no significant difference in age and sex composition of patients with heart failure,non heart failure group and control group(P > 0.05).There was no significant difference in age and sex composition of patients with different cardiac function classification(P > 0.05).2.There were significant differences in echocardiographic parameters of patients with heart failure,non heart failure group and control group(P < 0.05).The E/Ea of non heart failure group was significantly higher than that of the control group,.However,there were no significant differences in other echocardiographic parameters(LAD,LVEDD,MRA,LVEF)than those in the control group(P > 0.05).Patients with heart failure compared with non heart failure group and control group,the left ventricular end diastolic diameter was significantly increased,mitral regurgitation area was significantly increased,left ventricular ejection fraction was significantly reduced(P < 0.05).With the aggravation of heart failure,left atrial diameter,left ventricular end diastolic diameter,mitral regurgitation area,E/Ea gradually increased,ejection fraction decreased(P < 0.05).3.Comparison of B line score in patients with heart failure,non heart failure group and control group.There was no significant difference between B group and control group(P = 0.777).There was a significant difference between heart failure group and control group and non heart failure group(P < 0.05),the B line score of patients with heart failure group was significantly increased compared with the control group and the non heart failure group,and gradually increased with the aggravation of heart failure.4.Compared patients with plasma NT-pro BNP concentration in non heart failure group and heart failure group,NT-pro BNP concentration of heart failure patients increased significantly,than non heart failure patients,and with the severity of heart failure and gradually increased(P < 0.05).5.Pearson correlation coefficient was used to analyze the correlation between B score,echocardiography parameters and NT-pro BNP.There is no significant correlation between B score and the left atrial diameter line(r = 0.132,P = 0.201).B line score and left ventricular end diastolic diameter(r = 0.269,P = 0.008),mitral regurgitation area(r = 0.288,P = 0.004),E/Ea(r = 0.532,P = 0)and NT-pro BNP(r= 0.777,P = 0)had positive correlation(P < 0.05),and had negative correlation with the left ventricular ejection(r =-0.699,P = 0).6.The accuracy and positive rate of LVEF,B line score,LVEF combined with B line score and NT-pro BNP in the diagnosis of heart failure were drawn by ROC curve.NT-pro BNP AUC is 0.921(95% CI: 0.851-0.991),optimal cut-off is1105ng/l,sensitivity is 94.3%,specificity is 80.8%,positive predictive is 94.6%,negative predictive is 79.9%;LVEF AUC is 0.805(95% CI: 0.716-0.882),optimal cut-off is 48%,sensitivity is 86.1%,specificity is 66.7%,positive predictive is86.6%,negative predictive is 61.5%;B line score AUC is 0.821(95% CI: 0.729-0.891),optimal cut-off is 15,sensitivity is 91.4%.specificity is 69.2%,positive predictive is 91.4%,negative predictive is 69.3%.Th AUC of B line score combined with LVEF is 0.936(95% CI: 0.884-0.988),sensitivity is 98.6%,specificity is76.9%,positive predictive vis 93.8%,negative predictive is 93.8%.Conclusion:1.The B line score can reflect the changes of ventricular function,which is a very important reference for the evaluation of the severity of heart failure.2.The B line score of lung ultrasound has high sensitivity and specificity in the diagnosis of heart failure.3.The accuracy,sensitivity and specificity of the diagnosis of heart failure with pulmonary ultrasound combined with echocardiography can be improved.4.Bedside lung ultrasound has become a simple,real-time,feasible evaluation method in heart failure. |
PDF Full Text Request