<strong>Objective: </strong>To explore the value of real-time bedside ultrasonography in the etiologic diagnosis of acute dyspnea.<strong> Methods:</strong> Sixty-two patients with acute dyspne...<strong>Objective: </strong>To explore the value of real-time bedside ultrasonography in the etiologic diagnosis of acute dyspnea.<strong> Methods:</strong> Sixty-two patients with acute dyspnea who were treated in our hospital from January 2016 to December 2020 were randomly selected and their clinical data were retrospectively analyzed. All patients were randomly divided into a control group for routine examinations (n = 31) and an observation group for real-time beside ultrasonography (n = 31). The costs of medical examinations, examination duration, and diagnostic results of severe pneumonia, acute cardiogenic pulmonary edema, pulmonary embolism, chronic obstructive pulmonary disease, and pneumothorax (including sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy) of the two groups of patients were compared and analyzed. <strong>Results:</strong> Compared with the control group, the observation group had significantly shorter examinations (P < 0.05). Although the cost of medical examinations of the observation group tended to be higher, the difference between groups was not significant (P > 0.05). Moreover, there were no significant differences in left ventricular ejection fraction, left ventricular end-diastolic diameter, or brain natriuretic peptide between the two groups (P > 0.05). Comparison of the etiologic diagnosis results between the two groups showed that the observation group had significantly higher diagnostic sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for various causes compared with the control group (P < 0.05). <strong>Conclusion:</strong> Real-time bedside ultrasonography for the etiologic diagnosis of patients with acute dyspnea was quicker and had higher diagnostic accuracy;thus providing accurate guidance for the disease treatment, and having a higher promotional value in clinical practice compared with routine examinations.展开更多
Background The plasma N-terminal pro-B-type natriuretic peptide （NT-proBNP） level is frequently elevated in dyspnoeic patients and increasingly used in emergency departments to assess the cause of acute dyspnea.In t...Background The plasma N-terminal pro-B-type natriuretic peptide （NT-proBNP） level is frequently elevated in dyspnoeic patients and increasingly used in emergency departments to assess the cause of acute dyspnea.In this study we prospectively tested NT-proBNP levels in patients with congestive heart failure （CHF） and/or acute pulmonary embolism （APE） and determined the utility of NT-proBNP for discriminating APE from CHF.Methods A cohort of 177 dyspnoeic patients with a diagnosis of APE and/or CHF was prospectively studied between June 2010 and March 2013.NT-proBNP was measured by the electrochemiluminescence immunoassay （ECLIA）.All patients were evaluated with transthoracic echocardiography （TTE）.APE was diagnosed in the presence of thrombi signs in the pulmonary arteries with computed tomographic pulmonary angiography （CTPA） or a high-probability lung ventilation/ perfusion scan.Risk stratification was based on the evaluation on admission according to the ESC guidelines from 2008.The diagnosis of CHF was based on the guidelines of the American College of Cardiology/American Heart Association and the European Society of Cardiology.Two physicians independently reviewed the records to determine the final diagnosis.Results Fifty-nine patients met the criteria for dyspnea caused by APE,and 113 patients were diagnosed with CHF.Most of the APE patients （41,69.5%） were intermediate-risk.The symptoms and signs,such as orthopnea,paroxysmal nocturnal dyspnea and rales in the lungs,were more common in patients with CHF than in patients with APE （P 〈0.01）.Median NT-proBNP was significantly lower in patients with APE compared to those in patients with CHF （2 855.9 pg/ml vs.6 911.4 pg/ml,P 〈0.01）.We constructed the receiver operating characteristics （ROC） curve in predicting the diagnosis of APE.At a cut point=1 582.750 pg/ml,NT-proBNP provided a specificity of 93% and a true positive rate （sensitivity） of 17% for the diagnosis.At a cut point=3 390.000 pg/ml,NT-proBNP had a specificity of 83% and a sensitivity of 84% for the diagnosis of APE.At a cut point=6 486.500 pg/ml,they were 54% and 93% respectively.Conclusions NT-proBNP can assist in excluding CHF patients from those admitted to the emergency department with acute dyspnea and identifying patients with a high probability of APE,which would reduce the missed diagnosis of APE.Larger studies are necessary to validate these findings.展开更多
文摘<strong>Objective: </strong>To explore the value of real-time bedside ultrasonography in the etiologic diagnosis of acute dyspnea.<strong> Methods:</strong> Sixty-two patients with acute dyspnea who were treated in our hospital from January 2016 to December 2020 were randomly selected and their clinical data were retrospectively analyzed. All patients were randomly divided into a control group for routine examinations (n = 31) and an observation group for real-time beside ultrasonography (n = 31). The costs of medical examinations, examination duration, and diagnostic results of severe pneumonia, acute cardiogenic pulmonary edema, pulmonary embolism, chronic obstructive pulmonary disease, and pneumothorax (including sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy) of the two groups of patients were compared and analyzed. <strong>Results:</strong> Compared with the control group, the observation group had significantly shorter examinations (P < 0.05). Although the cost of medical examinations of the observation group tended to be higher, the difference between groups was not significant (P > 0.05). Moreover, there were no significant differences in left ventricular ejection fraction, left ventricular end-diastolic diameter, or brain natriuretic peptide between the two groups (P > 0.05). Comparison of the etiologic diagnosis results between the two groups showed that the observation group had significantly higher diagnostic sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for various causes compared with the control group (P < 0.05). <strong>Conclusion:</strong> Real-time bedside ultrasonography for the etiologic diagnosis of patients with acute dyspnea was quicker and had higher diagnostic accuracy;thus providing accurate guidance for the disease treatment, and having a higher promotional value in clinical practice compared with routine examinations.
文摘Background The plasma N-terminal pro-B-type natriuretic peptide （NT-proBNP） level is frequently elevated in dyspnoeic patients and increasingly used in emergency departments to assess the cause of acute dyspnea.In this study we prospectively tested NT-proBNP levels in patients with congestive heart failure （CHF） and/or acute pulmonary embolism （APE） and determined the utility of NT-proBNP for discriminating APE from CHF.Methods A cohort of 177 dyspnoeic patients with a diagnosis of APE and/or CHF was prospectively studied between June 2010 and March 2013.NT-proBNP was measured by the electrochemiluminescence immunoassay （ECLIA）.All patients were evaluated with transthoracic echocardiography （TTE）.APE was diagnosed in the presence of thrombi signs in the pulmonary arteries with computed tomographic pulmonary angiography （CTPA） or a high-probability lung ventilation/ perfusion scan.Risk stratification was based on the evaluation on admission according to the ESC guidelines from 2008.The diagnosis of CHF was based on the guidelines of the American College of Cardiology/American Heart Association and the European Society of Cardiology.Two physicians independently reviewed the records to determine the final diagnosis.Results Fifty-nine patients met the criteria for dyspnea caused by APE,and 113 patients were diagnosed with CHF.Most of the APE patients （41,69.5%） were intermediate-risk.The symptoms and signs,such as orthopnea,paroxysmal nocturnal dyspnea and rales in the lungs,were more common in patients with CHF than in patients with APE （P 〈0.01）.Median NT-proBNP was significantly lower in patients with APE compared to those in patients with CHF （2 855.9 pg/ml vs.6 911.4 pg/ml,P 〈0.01）.We constructed the receiver operating characteristics （ROC） curve in predicting the diagnosis of APE.At a cut point=1 582.750 pg/ml,NT-proBNP provided a specificity of 93% and a true positive rate （sensitivity） of 17% for the diagnosis.At a cut point=3 390.000 pg/ml,NT-proBNP had a specificity of 83% and a sensitivity of 84% for the diagnosis of APE.At a cut point=6 486.500 pg/ml,they were 54% and 93% respectively.Conclusions NT-proBNP can assist in excluding CHF patients from those admitted to the emergency department with acute dyspnea and identifying patients with a high probability of APE,which would reduce the missed diagnosis of APE.Larger studies are necessary to validate these findings.
