The Application Value Of Pulmonary Ultrasound In The Diagnosis And Treatment Of Decompensated Patients With Heart Failure

Objective:By observing the correlation among the indicators of B-line score of pulmonary ultrasound and cardiac ultrasound(E/Ea,S/D,LAVI,LVEF,GLPS),and BNP in different cardiac functional grading of patients with chronic heart failure and each group changes in the above indicators before and after treatment,this article is aimed at discussing about the practical value of ultrasound in the aspects of the diagnosis and treatment for patients with heart failure.Methods:Patients who were diagnosed with decompensated chronic heart failure and patients who were received treatment at the First Affiliated Hospital of Kunming Medical University from October 2017 to January 2018 are selected as the experimental group(Group A1 with Cardiac Function Level ?,Group A2 with Cardiac Function Level ? and Group A3 with Cardiac Function Level ?,the standard for dividing the group is based on the cardiac function level of the patients before receiving treatment);while Post-operative patients are selected as control group(Group B1 with Cardiac Function Level ?,Group B2 with Cardiac Function Level ?,Group B3 with Cardiac Function Level IV):52 cases in total,consisting of 36 males,and 16 females,the average age is(60.76±12.89)years,besides,all the patients have signed informed consent forms before participating in the study.(Cardiac function level ? was transferred to cardiac function level I,cardiac function level ? to cardiac function level ?,and cardiac function level ? to cardiac function level ? to ?).Inclusion Criteria:1 It is required to meet the diagnostic criteria of the guidelines of 2016 ESC Heart Failure Treatment.2 It is required to have a history of basic cardiovascular disease such as hypertension,coronary heart disease,and dilated cardiomyopathy;3 The NYHA of the patients are evaluated by the clinician as Level ?-?.Exclusion Criteria:1 Age ?18 years;2 Pregnancy,malignant tumor,congenital heart disease,pulmonary fibrosis,severe pneumonia and ARDs,acute myocardial infarction;3 Patients with valve stenosis and atrial fibrillation during examination.4 Patients whose image with poor quality and cannot be further analyzed.All the subjects are treated in line with the 2016 guidelines for heart failure.within 24 hours after admission,and before the day when the patient meets the discharge criteria after the assessment of clinician,BNP test is carried out both in experimental groups and control groups;Two-dimensional echocardiography and real-time three-plane echocardiography are performed on the experimental group and the control group.The view of two-dimensional parasternal long axis cross section of left ventricular is collected and stored(Appendix Figure 1),dynamic images of apical four-chamber(Appendix Figure 2),and apical two-chamber(Appendix Figure 3)are analyzed by using the Simpson dual-pane method,then the left ventricular ejection fractions(LVEF)of experimental groups and control groups are obtained.(Appendix Figure 4),the area-length method is put into use to measure the left atrial volume(LAV)and its diameter(LAD)(Appendix Figure 5),in addition to figure out the left atrial volume Index with the application of formula(Left Atrial Volume Index,LAVI),and the ratio of early mitral diastolic flow peak value and mitral tissue Doppler early diastolic peak value(Appendix Figure 6-8),measuring the four-chamber view and the pulmonary vein spectrum from the right upper pulmonary vein(S/D)(Appendix Figure 9),and the speckle tracking imaging(STI)is used to analyze the real-time three-plane dynamic image(Figure 10),it obtains the bull's eye-shape strain diagram of longitudinal systolic peak value corresponding to the 17 segments of the left ventricle(6 horizontal segments of mitral valve,6 horizontal segments of papillary muscle,4 horizontal segments of cardiac apex,and apical cap)as well as the average vertical strain peak value of the three planes of the left ventricle:Apical four-chamber view long axis average strain peak value(GLPS-A4C),apical left ventricular long axis view(three-chamber heart)average strain peak value(GLPS-LAX),apical two-chamber view long axis average strain peak value(GLPS-A2C)and left ventricular long axis average strain peak value are shown inFigure 11(GLPS)(Appendix Figure 11).After the echocardiogram is completed,the patient is asked to be in both a supine position and a seated position,and meanwhile,the other sonographer uses a low-frequency probe to perform an immediate pulmonary ultrasound examination to obtain ULTRAsound lung comets(ULCs).(Appendix Figure 13),and a B line score.Spearson correlation analysis is used to obtain the scoring correlation coefficients among absolute strain peak valueof the left ventricular long axis(GLSP),E/Ea,S/D,LAVI,BNP,LVEF,and ULCs.Comparing the left ventricular vertical average stain peak value,the left ventricle three planes vertical average strain value,and the left ventricle ejection fraction(LVEF)of the experimental group((Group A1 with Cardiac Function Level ?,Group A2 with Cardiac Function Level ? and Group A3 with Cardiac Function Level ?)and E/Ea,S/D,BNP,and LAVI,and analyzing their correlations with ULCs,the paired t test is completed both in the pre-treatment experimental groups,namely,A1,A2,and A3,and post-treatment control group,namely,B1,B2,B3,meanwhile,the SPSS 17.0 statistical software package is used for statistical analysis,if P<0.05,it indicates that the difference is of statistically significant.Results:1.Based on the ?2 test and the variance of completely random design data,it analyzes the basic information between Level ?,Level ?,and Level ? of cardiac function:Showing no statistically difference in terms of gender and age(P>0.05);In accordance with ?2 test,there is no statistical difference in pre-existing illness and underlying disease among different groups with cardiac function,such as:diabetes,coronary heart disease,dilated cardiomyopathy,hypertension(P>0.05).Drug use of different groups with cardiac function according to the analysis of ?2 test:There is no significant difference in spironolactone,beta blockers,and ACEI/ARB(P>0.05).According to the analysis on the variance of completely random design data,it is found that there is no statistically significant difference in hospital stay between different groups with concentric function(P>0.05).2.The analysis on the variance of completely random design data shows that among cardiac function Level ?,Level ?,and Level ?:ULCs,LVEF,E/Ea,LAVI are of statistically significance(P<0.001),then it further carries out LSD-t comparison among Level ?,Level ?,and Level ?,which shows that there is a statistically significant difference between each level of the two groups,while there is no statistically significant difference in S/D,GLPS-Avg,GLPS-LAX,GLPS-A4C,and GLPS-A2C.(P>0.05).The rank sum test of multiple samples of BNP indicates that the difference in BNP is statistically significant(P<0.001),then it further makes LSD-t comparisons between Level ?,Level ?,and Level ? respectively,and finds that they are statistically significant(P<0.001).<0.05).It can be concluded that ULCs,LVEF,E/Ea,LAVI and other indicators can be used to assess the severity of heart failure.3.Paired t-tests between pre-treatment and post-treatment groups with cardiac function Level ?,Level ?,and Level ? prompts that:Differences in E/Ea,S/D,LAVI,ULCs,GLPS-Avg,GLPS-LAX,GLPS-A4C,GLPS-A2C,LVEF,are statistically significant(P<0.05).Rank sum tests on two related samples of BNP between pre-treatment and post-treatment groups with cardiac function,it is concluded that there is a statistically significant difference in BNP of pre-treatment and post-treatment(P<0.05).It indicates that E/Ea,S/D,LAVI,ULCs,GLPS-Avg,GLPS-LAX,GLPS-A4C,GLPS-A2C,BNP,LVEF can be used to evaluate the therapeutic effect.4.The spearman correlation analysis shows that:ULCs is correlated with BNP(r=0.73,P<0.05)and Pearson correlation analysis shows that:ULCs and Ventricular Diastolic Function index E/Ea(r=0.62,P<0.05),LAVI(r=0.57,P<0.05),ULCs and Ventricular Systolic Function index LVEF(r=-0.23,P<0.05),GLPS-Avg(r=-0.54,P<0.05),GLPS-LAX(r=-0.47,P<0.05),GLPS-A4C(r=-0.52,P)<0.05),GLPS-A2C(r=-0.5,P<0.05)are correlated,while ULCs and Ventricular Systolic Function S/D index(r=-0.25,P=0.074)is not correlated.Therefore,the correlation between lung ultrasound,diastolic function index and the systolic function index are better.5.According to the ROC curve(subject working curve),it can be concluded that the sensitivity of BNP in diagnosis of diastolic and systolic heart failure is 0.92,specificity is 0.91,P<0.001,and the critical value is 40.32.The sensitivity of ULCs in diagnosing diastolic and systolic heart failure is 0.84,the specificity is 0.91,P<0.001,and the critical value is 6.28;while the sensitivity of E/Ea in diagnosing diastolic systolic heart failure is 0.78,the specificity is 0.69,and the critical value is 15.27.The sensitivity of the three in diagnosing diastolic and systolic heart failure is85.36%,and the specificity is 90.91%.Conclusion:1.Changes of cardiac function not only can be assessed by pulmonary ultrasound scores can be used as a reference to assess the severity of heart failure and changes of cardiac function,but also can reflect the change of therapeutic effect,which can provide reference for evaluating the treatment effect of heart failure.2.The correlation between lung ultrasound score and diastolic function,systolic function is relatively better,suggesting that lung ultrasound combined with echocardiography can better evaluate left cardiac diastiolic systolic function.3.Pulmonary ultrasound have better specificity,sensitivity in diagnosis of diastolic systolic heart failure.