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Olesen ASO, Miger K, Thune JJ, Nielsen OW, Jakobsen JC, Grand J. Diagnostic Methods for Pulmonary Congestion and Pleural Effusion: A Protocol for a Systematic Review and Meta-Analysis. Acta Anaesthesiol Scand 2025; 69:e70042. [PMID: 40311657 PMCID: PMC12045659 DOI: 10.1111/aas.70042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2025] [Accepted: 04/07/2025] [Indexed: 05/03/2025]
Abstract
BACKGROUND Pulmonary congestion and pleural effusion are key manifestations in patients with acute heart failure, contributing to over one million emergency department admissions annually in, respectively, the United States and Europe. Accurate and timely diagnosis is critical for initiating early treatment and optimizing patient outcomes. Routinely used diagnostic tools, such as chest radiography, have limitations in sensitivity and specificity. Emerging imaging modalities, including lung ultrasound, computed tomography (CT), and remote dielectric sensing (ReDS), may offer improved diagnostic accuracy, but their comparative effectiveness remains unclear. METHODS We will conduct a systematic review and meta-analysis following PRISMA-P guidelines to assess the diagnostic accuracy of chest radiography, lung ultrasound, CT, and ReDS for pulmonary congestion and pleural effusion. We will include prospective diagnostic studies comparing these modalities to a reference standard of pulmonary congestion or pleural effusion. Our search will cover MEDLINE, Embase, CENTRAL, and other major databases, without language restrictions. We will begin our search in April 2025. Sensitivity, specificity, and likelihood ratios will be pooled using a hierarchical summary receiver operating characteristic model. Risk of bias will be assessed using QUADAS-2. DISCUSSION This protocol defines the detailed methodology and approach used for a systematic review that will provide a comprehensive assessment of current diagnostic modalities for pulmonary congestion and pleural effusion. By comparing their diagnostic accuracy, we aim to guide clinicians in selecting the most effective tools for clinical practice. Additionally, identifying gaps and the risk of bias in existing research may inform future studies and advancements in acute heart failure diagnostics.
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Affiliation(s)
- Anne Sophie Overgaard Olesen
- Department of CardiologyCopenhagen University Hospital–Bispebjerg and FrederiksbergCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Kristina Miger
- Department of CardiologyCopenhagen University Hospital–Bispebjerg and FrederiksbergCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Jens Jakob Thune
- Department of CardiologyCopenhagen University Hospital–Bispebjerg and FrederiksbergCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | | | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Department of Regional Health Research, Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
| | - Johannes Grand
- Department of CardiologyCopenhagen University Hospital–Amager and HvidovreCopenhagenDenmark
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Bjällmark A, Hummel G, Shahgaldi K. Diagnostic value of combined heart and lung ultrasound in emergency department patients with dyspnea. Clin Physiol Funct Imaging 2025; 45:e70009. [PMID: 40243381 PMCID: PMC12005122 DOI: 10.1111/cpf.70009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 02/19/2025] [Accepted: 04/03/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Acute dyspnea in emergency departments (ED) requires prompt and accurate diagnosis due to its high mortality and readmission rates. Conventional diagnostic methods are resource-intensive and time-consuming. This study aimed to evaluate the diagnostic accuracy and time to diagnosis of combined heart and lung ultrasound (HeaLus) compared to standard emergency department evaluation in patients presenting with dyspnea. METHODS A prospective study was conducted in a cohort of 61 patients at the ED of Danderyd Hospital, Sweden. HeaLus examinations were performed alongside routine investigations. Diagnostic performance of HeaLus and ED evaluation was assessed for accuracy, sensitivity, specificity, positive predictive value, and negative predictive value, and agreement using Kappa index. Median time to diagnostics was compared between HeaLus and ED evaluation using Mann-Whitney U-test. RESULTS Heart failure was the most common diagnosis (20%) among patients presenting with dyspnea. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 95% (95% CI: [87%, 98%]), 98% (95% CI: [88%, 100%]), 90% (95% CI: [69%, 97%]), 95% (95% CI: [85%, 99%]), and 94% (95% CI: [74%, 99%]), respectively. The agreement between HeaLus and ED diagnoses was 0.88. Time to diagnosis was significantly reduced with HeaLus (21 min vs. 3 h and 28 min). CONCLUSIONS HeaLus offers rapid and accurate assessment of dyspnea. These results suggest that HeaLus could be valuable in optimizing patient management, particularly in settings with limited resources and long ED wait times.
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Affiliation(s)
- Anna Bjällmark
- Department of Clinical Diagnostics, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Gustaf Hummel
- Department of CardiologyDanderyd HospitalDanderydSweden
| | - Kambiz Shahgaldi
- Department of Clinical PhysiologyDanderyd HospitalDanderydSweden
- Karolinska Institutet, Department of Clinical SciencesDanderyd HospitalDanderydSweden
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Babafemi EO, Cherian BP, Rahman K, Mogoko GM, Abiola OO. Diagnostic accuracy of real-time polymerase chain reaction assay for the detection of Trichomonas vaginalis in clinical samples: A systematic review and meta-analysis. Afr J Lab Med 2025; 14:2522. [PMID: 40356692 PMCID: PMC12067014 DOI: 10.4102/ajlm.v14i1.2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 01/24/2025] [Indexed: 05/15/2025] Open
Abstract
Background Vaginal trichomoniasis is a highly prevalent parasitic infection associated with HIV acquisition and preterm birth. The 'gold standard' for its diagnosis requires 3-7 days to detect by culture. Rapid and accurate diagnosis, such as by nucleic acid amplification testing, is key to manage the disease, and control and prevent its transmission. Aim This review aimed to assess the overall accuracy of real-time polymerase chain reaction (RT-PCR)-based assays, for routine diagnosis of Trichomonas vaginalis in clinical vaginal samples from women with symptomatic/asymptomatic trichomoniasis, using Trichomonads culture as the gold standard. Methods MEDLINE, PubMed, EMBASE, and other sources were used to search for included studies published between 01 January 1995 and 31 July 2023. The search terms 'real-time polymerase chain reaction', 'real-time', 'polymerase chain reaction', 'Trichomonas vaginalis', 'trichomonas', 'vaginalis', 'humans', 'rt pcr', 'nucleic acid amplification test', 'NAAT', 'trichomonad culture', 'women' were included. Summary estimates were calculated for the overall accuracy of the assay compared to Trichomonads culture as the reference standard. Meta-analysis was conducted using a bivariate meta-regression model. Results Twenty-seven eligible studies met our inclusion criteria: sensitivity 99% (95% confidence interval [CI] 99-100), specificity 100% (95% CI 100-100), positive likelihood ratio 350.67 (167.42-734.49), negative likelihood ratio 0.02 (0.01-0.03), diagnostic odds ratio 23 064.05 (95% CI 8532.13-62 346.77), and area under receiver operating characteristics curve 0.99. There was significant heterogeneity in sensitivity and specificity (p < 0.001). Conclusion Our results suggested that RT-PCR assays could be useful for the diagnosis of vaginal trichomoniasis with high sensitivity and specificity. What this study adds This article provides a comprehensive review of the effectiveness of RT-PCR assays for the diagnosis of trichomoniasis with high sensitivity and specificity in comparison to other methods in clinical laboratory practice. The goal is to present awareness/evidence that this assay is more accurate and rapid than other techniques.
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Affiliation(s)
- Emmanuel O Babafemi
- Department of Pharmacy and Biomolecular Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Benny P Cherian
- Department of Microbiology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Khalid Rahman
- Department of Pharmacy and Biomolecular Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Gilbert M Mogoko
- Department of Microbiology, IPP Pathology First, Dobson House, Bentalls, Basildon, United Kingdom
| | - Oluwatoyin O Abiola
- Department of Computer Science, Faculty of Science, Afe Babalola University, Ado Ekiti, Nigeria
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Olesen ASO, Miger K, Sajadieh A, Abild-Nielsen AG, Pedersen L, Schultz HHL, Grand J, Thune JJ, Nielsen OW. Remote dielectric sensing to detect pulmonary congestion in acute dyspnoeic patients: Reproducibility and the effect of pulmonary comorbidities. Int J Cardiol 2025; 425:133068. [PMID: 39956459 DOI: 10.1016/j.ijcard.2025.133068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 01/28/2025] [Accepted: 02/13/2025] [Indexed: 02/18/2025]
Abstract
BACKGROUND Remote Dielectric Sensing (ReDS) is a fast and non-invasive method that estimates lung fluid. We previously described moderate accuracies for ReDS to detect acute heart failure in consecutive patients. We hypothesise that unprecise ReDS values may stem from concomitant pulmonary diseases. PURPOSE To examine the ReDS reproducibility and the effect of pulmonary comorbidities on ReDS values in acute dyspnoeic patients. METHODS This prospective observational study included 97 consecutive patients ≥50 years with acute dyspnoea. Upon admission, patients underwent low-dose chest computed tomography (CT), echocardiography and ReDS examination. ReDS is by default performed on the right hemithorax in sitting position. For reproducibility comparisons, we conducted additional ReDS measurements two centimetres above and below the default placement, and in sitting and supine position. Two blinded radiologists evaluated the CT scans for pulmonary congestion and pulmonary diseases. RESULTS Comparing three ReDS measurements on the right hemithorax revealed coefficients of variations of 9.6 %, 8.2 %, and 8.3 %. For sitting versus supine comparison, the coefficient of variation was 9.5 % for the default ReDS placement. Patients with CT-verified pulmonary congestion had a coefficient of variation of 5.9 % in sitting versus supine comparison, while those without had 10.3 %. In multivariable regression, lower ReDS values were observed in patients with pneumonia (-1.81, p = 0.215, N = 51), emphysema (-5.44, p = 0.001, N = 26), and higher in fibrosis (5.58, p = 0.032, N = 8) and congestion (5.79, p = 0.002, N = 17), compared to those without. CONCLUSION ReDS values of lung fluid content and reproducibility were affected by pulmonary diseases. ReDS showed consistent reproducibility for patients with CT-verified pulmonary congestion.
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Affiliation(s)
- Anne Sophie Overgaard Olesen
- Dept of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Kristina Miger
- Dept of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ahmad Sajadieh
- Dept of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | | | - Lars Pedersen
- Dept of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Hans Henrik Lawaetz Schultz
- Dept of Cardiology, Unit of Lung Transplantation, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Johannes Grand
- Dept of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Jens Jakob Thune
- Dept of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Dept of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Long B, Brady WJ, Gottlieb M. Emergency medicine updates: Sympathetic crashing acute pulmonary edema. Am J Emerg Med 2025; 90:35-40. [PMID: 39799613 DOI: 10.1016/j.ajem.2024.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 12/11/2024] [Accepted: 12/19/2024] [Indexed: 01/15/2025] Open
Abstract
INTRODUCTION Patients with heart failure exacerbation can present in a variety of ways, including sympathetic crashing acute pulmonary edema (SCAPE). Emergency physicians play a key role in the diagnosis and management of this condition. OBJECTIVE This narrative review evaluates key evidence-based updates concerning the diagnosis and management of SCAPE for the emergency clinician. DISCUSSION SCAPE is a subset of acute heart failure, defined as a patient with sudden, severe pulmonary edema and hypertension, resulting respiratory distress, and hypoxemia. This is associated with significantly elevated afterload with fluid maldistribution into the pulmonary system. Evaluation and resuscitation should occur concurrently. Laboratory assessment, electrocardiogram, and imaging should be obtained. Point-of-care ultrasound is a rapid and reliable means of confirming pulmonary edema. Management focuses on respiratory support and vasodilator administration. Noninvasive positive pressure ventilation (NIPPV) with oxygen support is associated with reduced need for intubation, improved survival, and improved respiratory indices. If the patient does not improve or decompensates on NIPPV, endotracheal intubation is recommended. Rapid reduction in afterload is necessary, with the first-line medication including nitroglycerin. High-dose bolus nitroglycerin is safe and effective, followed by an infusion. If hypertension is refractory to NIPPV and high-dose nitroglycerin, other agents may be administered including clevidipine or nicardipine. Angiotensin-converting enzyme inhibitors such as enalaprilat are an option in those with normal renal function and resistant hypertension. Diuretics may be administered in those with evidence of systemic volume overload (e.g., cardiomegaly, peripheral edema, weight gain), but should not be routinely administered in patients with SCAPE in the absence of fluid overload. Caution is recommended in utilizing opioids and beta blockers in those with SCAPE. CONCLUSION An understanding of the current literature concerning SCAPE can assist emergency clinicians and improve the care of these patients.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Deniau B, Asakage A, Takagi K, Gayat E, Mebazaa A, Rakisheva A. Therapeutic novelties in acute heart failure and practical perspectives. Anaesth Crit Care Pain Med 2025; 44:101481. [PMID: 39848331 DOI: 10.1016/j.accpm.2025.101481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/06/2024] [Accepted: 11/04/2024] [Indexed: 01/25/2025]
Abstract
Acute Heart Failure (AHF) is a leading cause of death and represents the most frequent cause of unplanned hospital admission in patients older than 65 years. Since the past decade, several randomized clinical trials have highlighted the importance and pivotal role of certain therapeutics, including decongestion by the combination of loop diuretics, the need for rapid goal-directed medical therapies implementation before discharge, risk stratification, and early follow-up after discharge therapies. Cardiogenic shock, defined as sustained hypotension with tissue hypoperfusion due to low cardiac output and congestion, is the most severe form of AHF and mainly occurs after acute myocardial infarction, which can progress to multiple organ failure. Although its prevalence is relatively low, cardiogenic shock complicates 12% of acute myocardial infarction. After a brief summary of the epidemiology of AHF and cardiogenic shock, followed by key pathophysiological points, we detailed current treatments in AHF and cardiogenic shock what every anaesthesiologist and intensivist needs to know, based on the latest guidelines and randomized clinical trials published in recent years.
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Affiliation(s)
- Benjamin Deniau
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Paris Cité University, Paris, France; FHU PROMICE, Paris, France; INI CRCT Network, Nancy, France.
| | - Ayu Asakage
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Takagi
- Momentum Research Inc, Durham, NC, United States
| | - Etienne Gayat
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Paris Cité University, Paris, France; FHU PROMICE, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Paris Cité University, Paris, France; FHU PROMICE, Paris, France; INI CRCT Network, Nancy, France
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Ienghong K, Khemtong S, Cheung LW, Apiratwarakul K. Enhanced Diagnostic Precision in Revisited Emergency Patients via Point-of-Care Ultrasound: A Tool for Emergency Department Quality Management. J Multidiscip Healthc 2025; 18:1549-1556. [PMID: 40125301 PMCID: PMC11929508 DOI: 10.2147/jmdh.s507075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 03/13/2025] [Indexed: 03/25/2025] Open
Abstract
PURPOSE Unscheduled return visits to the emergency department (ED) were categorized into physician-related, illness-related, and patient-related factors, which are associated with an increased risk of adverse health outcomes, including patient dissatisfaction, infections, hospitalization, transfer to another facility, and mortality. Individuals within 48-72 hours of the initial visit are deemed at elevated risk for diagnostic or management-related errors. The Point-of-care ultrasound (POCUS) may serve as a bedside tool to reduce medical errors by enhancing diagnostic precision. This study aims to determine the diagnostic accuracy of POCUS for detecting various illnesses in revisited patients in the emergency department. PATIENTS AND METHODS A retrospective observational study was conducted on unplanned revisits by patients to the emergency department within 72 hours, spanning the period from January 2023 to September 2024. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were evaluated based on electronic emergency department medical records and ultrasound documentation. RESULTS Five hundred seventy patients were included in this study. POCUS demonstrated a diagnostic accuracy of 75.61% (95% CI 71.87, 79.09), a sensitivity of 81.87% (95% CI 77.65, 85.58), a specificity of 62.50% (95% CI 55.08, 69.51), a positive likelihood ratio of 2.18 (95% CI 1.80, 2.65), and a negative likelihood ratio of 0.29 (95% CI 0.23, 0.37). CONCLUSION POCUS demonstrated greater diagnostic accuracy, which may enhance diagnostic precision in revisited patients with various illnesses.
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Affiliation(s)
- Kamonwon Ienghong
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sukanya Khemtong
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lap Woon Cheung
- Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong
- Department of Emergency Medicine, Li ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Korakot Apiratwarakul
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Platz E, McDowell K, Gupta DK, Claggett B, Brennan A, Charles LJ, Cunningham JW, Dixon DD, Docherty KF, Jering K, Oggs R, Palacios J, Schwede M, Ravi KS, Sukumar SM, Wassenaar JW, Lewis EF, McMurray JJV, Campbell RT. Pulmonary Congestion on Lung Ultrasound in Ambulatory Patients With Heart Failure With Preserved Ejection Fraction. J Card Fail 2025:S1071-9164(25)00099-5. [PMID: 40054838 DOI: 10.1016/j.cardfail.2025.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 02/27/2025] [Accepted: 02/27/2025] [Indexed: 04/08/2025]
Abstract
BACKGROUND Early detection of pulmonary congestion among ambulatory patients with heart failure with preserved ejection fraction (HFpEF) is critical to optimize decongestive therapy before overt decompensation, yet traditional tools are insensitive. We sought to examine the prevalence of B-lines, an ultrasound measure of pulmonary congestion, and their clinical and imaging correlates in patients with HFpEF. METHODS AND RESULTS In a prospective, multisite observational study, using a pocket ultrasound device, 8-zone lung ultrasound examination was performed in outpatients with HFpEF, left ventricular ejection fraction (LVEF) of ≥45% and New York Heart Association functional class II through IV. B-lines and cardiac structure and function from echocardiograms were quantified off-line in core laboratories, blinded to clinical findings. Among 415 participants (mean age 74 years, 52% women, 51% obese, median N-terminal pro-B-type natriuretic peptide [NT-proBNP] 744 pg/mL) B-lines were detectable in 78% of patients ranging from 0 to 36 (median 3, interquartile range 1-6). There was a linear association between B-line count and log-transformed NT-proBNP (P < .001). Among patients in the highest tertile of B-lines, 76% had no crackles on auscultation, and 50% did not have elevated NT-proBNP levels. A higher B-line count was associated with larger sizes of cardiac chambers, greater left ventricular mass, higher filling pressures (E/e'), tricuspid regurgitant velocity, and inferior vena cava size, and worse right ventricular systolic function (P for trend < .05 for all), but not left ventricular ejection fraction. CONCLUSIONS Among ambulatory patients with HFpEF, lung ultrasound-detected B-lines were common, associated with NT-proBNP levels and clinically important echocardiographic features, and identified pulmonary congestion that was not always evident by auscultation.
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Affiliation(s)
- Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
| | - Kirsty McDowell
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Deepak K Gupta
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Alice Brennan
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Lawrence J Charles
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan W Cunningham
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Debra D Dixon
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kieran F Docherty
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Karola Jering
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Rashundra Oggs
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia Palacios
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Madeleine Schwede
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Katherine Scovner Ravi
- Renal Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Shivasankar M Sukumar
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jean W Wassenaar
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eldrin F Lewis
- Cardiovascular Division, Stanford University School of Medicine, Palo Alto, California
| | - John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Ross T Campbell
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
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Daniels LB, Ajongwen P, Christenson RH, Clark CL, Diercks DB, Fermann GJ, Mace SE, Mahler SA, Pang PS, Rafique Z, Runyon MS, Tauras J, deFilippi CR. Clinical Performance of an N-Terminal Pro-B-Type Natriuretic Peptide Assay in Acute Heart Failure Diagnosis. J Appl Lab Med 2025; 10:325-338. [PMID: 39495056 DOI: 10.1093/jalm/jfae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/09/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND We evaluated the Vitros® Immunodiagnostic Products N-terminal pro B-type natriuretic peptide (NT-proBNP) II assay for aiding in diagnosis of heart failure (HF) in patients with acute dyspnea. METHODS Serum concentrations of NT-proBNP were measured in patient samples from 20 emergency departments across the United States. Study endpoints included sensitivity, specificity, likelihood ratios, and predictive values for diagnosis of acute HF according to age-stratified cutoffs (450, 900, and 1800 pg/mL), and a rule-out age-independent cutoff (300 pg/mL). Additional measures were area under the curve (AUC) for receiver operating characteristic (ROC) curves. Results were also interpreted in patient subgroups with relevant comorbidities, and gray zone/intermediate assay values. RESULTS Of 2200 patients, 1095 (49.8%) were diagnosed with HF by clinical adjudication. Sensitivity and specificity for Vitros NT-proBNP II ranged from 84.0% to 92.1%, and 81.4% to 86.5%, respectively, within and across age groups, and positive predictive values were 80.4% to 85.7%. Using the rule-out cutoff, the negative predictive value was 97.9%, with a negative likelihood ratio of 0.02. In subgroups with comorbidities potentially affecting NT-proBNP concentrations, sensitivities ranged from 82.6% to 89.5%, and AUCs for ROC curves were 0.899 to 0.915. CONCLUSIONS The Vitros NT-proBNP II assay demonstrated excellent clinical performance using age-stratified cutoffs along with other clinical information for supporting diagnosis of HF, and can rule out HF with a high negative predictive value using the age-independent cutoff. The assay retained utility in patient subgroups with conditions that influence NT-proBNP concentration, and for those with gray zone results. CLINICALTRIALS.GOV REGISTRATION NUMBER NCT03548909.
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Affiliation(s)
- Lori B Daniels
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Patience Ajongwen
- Department of Biostatistics & Clinical Data Management/Science, QuidelOrtho Corporation, Raritan, NJ, United States
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Carol L Clark
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States
| | - Deborah B Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Sharon E Mace
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Simon A Mahler
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Zubaid Rafique
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Michael S Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, United States
| | - James Tauras
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
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Regan ML, Bischof JJ, Bush M, Waller AE, Platts-Mills TF, Casey MF, Meyer ML. Sex and age differences in atypical chief complaints for acute decompensated heart failure in the emergency department. Clin Exp Emerg Med 2025; 12:47-55. [PMID: 38778488 PMCID: PMC12010806 DOI: 10.15441/ceem.24.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE About one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing the presentation of ED symptoms among ADHF patients may improve clinical care; however, sex and age differences in ED chief complaints have not been thoroughly investigated. In this paper, we describe differences in chief complaints and comorbid conditions for ED patients with ADHF diagnoses, stratified by sex and age. METHODS We conducted a retrospective analysis of adults presenting to North Carolina EDs using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a statewide syndromic surveillance system, between 2010 and 2016, screening for patients with a diagnosis of ADHF. We evaluated frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, and computed standardized differences. RESULTS The most common chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 years age group, women were more likely than men to report nausea/vomiting (6.7% vs. 4.1%) and headache (4.2% vs. 2.0%). In those 45-64 and ≥65 years, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 years age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the ≥65 years age group. CONCLUSION Differences in atypical ADHF symptoms were seen in in ED patients based on sex and age. Understanding the variation in ADHF symptoms among ED patients can facilitate the identification of ED patients with ADHF and improve management of ADHF-related symptoms.
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Affiliation(s)
- Matthew L. Regan
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna E. Waller
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Martin F. Casey
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Oliveira IJ, Delgado BM, Mota C, Gomes I, Ferreira PL. London Chest Activity of Daily Living: Reliability and Validity of the European Portuguese Version in Heart Failure Patients. Healthcare (Basel) 2025; 13:377. [PMID: 39997252 PMCID: PMC11855288 DOI: 10.3390/healthcare13040377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 01/30/2025] [Accepted: 01/31/2025] [Indexed: 02/26/2025] Open
Abstract
Background/Objectives: The common heart failure (HF) symptoms-dyspnea, fatigue, and edema-often prompt emergency visits. Dyspnea notably affects activities of daily living (ADLs), making its assessment crucial for evaluating therapeutic success. This study assesses the reliability and validity of the European Portuguese version of the London Chest Activity of Daily Living (LCADL) scale, originally validated in 2010, to evaluate ADL limitations in patients with HF. Methods: Following international guidelines for translation and cultural adaptation, 46 patients with HF from two cardiology departments were enrolled. The Six Minute Walk Test (6MWT) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used for construct validity. Results: A significant correlation was found between the results of the 6MWT and the LCADL total score (r = -0.504; p < 0.001) and the LCADL scale and the MLHFQ (r = 0.703; p < 0.001), except for the domestic activities dimension (r = 0.278; p = 0.062). Reliability revealed an α of 0.917. Conclusions: The study presents the validation of the European Portuguese version of the LCADL scale in patients with HF, emphasizing its reliability and cultural appropriateness. The LCADL scale has proven effective in assessing dyspnea-induced limitations in ADLs, and this study expands its utility by suggesting broader clinical setting applications. Future research should explore its adaptability in diverse healthcare settings, potentially enhancing personalized care strategies and patient outcomes. This work underscores the LCADL scale's role in facilitating more targeted and effective interventions for managing ADL limitations in patients with HF, suggesting a significant impact on clinical practices and patient care management.
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Affiliation(s)
- Isabel J. Oliveira
- Fernando Pessoa University, Praça de 9 de Abril, 4249-004 Porto, Portugal
- Center for Health Studies and Research of the University of Coimbra, Avenida Dias da Silva, 3004-512 Coimbra, Portugal;
| | - Bruno M. Delgado
- Cardiology Department, Santo António University Hospital Center, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal;
| | - Cecília Mota
- Cardiology Department of the Arrabida Local Unit, 2910-446 Setúbal, Portugal;
| | - Inês Gomes
- Human and Social Sciences Faculty, Fernando Pessoa University, 4249-004 Porto, Portugal;
| | - Pedro Lopes Ferreira
- Center for Health Studies and Research of the University of Coimbra, Avenida Dias da Silva, 3004-512 Coimbra, Portugal;
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12
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Bianchi G, Vizio B, Bosco O, Schiavello M, Cagna Vallino P, Rumbolo F, Morello F, Mengozzi G, Montrucchio G, Lupia E, Pivetta E. miR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study. Int J Mol Sci 2025; 26:1278. [PMID: 39941043 PMCID: PMC11818144 DOI: 10.3390/ijms26031278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 01/27/2025] [Accepted: 01/29/2025] [Indexed: 02/16/2025] Open
Abstract
Acute cardiogenic pulmonary edema (ACPE) is a common and serious manifestation of heart failure (HF), representing 10-20% of all acute HF admissions. It is associated with elevated in-hospital mortality and high rates of re-hospitalization. MicroRs, like miR-30d, are of particular interest in heart failure due to their regulatory role in gene expression and potential as biomarkers for diagnosing and predicting patient outcomes, especially in high-risk cases such as ACPE. We conducted a cohort study on patients diagnosed with ACPE in the Emergency Department (ED). The circulating levels of miR-30d were analyzed at the time of hospital admission and at one-month follow-up along with other biomarkers. We enrolled 24 ACPE patients and 10 control subjects. Median age was 80.8 years (interquartile range, IQR, 8.2) in ACPE cases, and 78.5 years (IQR 9.8) in controls with a male/female ratio of 2 and 0.66, respectively. In ACPE patients, median cardiac ejection fraction was 42.5%, creatinine 1.63 mg/dL (IQR 1.24), troponin 63.5 ng/dL (58), and NT-proBNP 4243.5 pg/mL (IQR 5846) at ED evaluation. Median concentration of miR30d was 0.81 in controls, and 3.67 and 7.28 in ACPE patients at enrollment time and one month later, respectively. Re-hospitalization occurred in 7 ACPE patients in the following 3 months, and in 9 during the following year. miR-30d had a significant predictive value in assessing the risk of re-hospitalization at both 3 months and 1 year following the initial diagnosis of ACPE, while it did not in assessing the risk of death at 1 year. When compared with the other biomarkers, none of them showed a better accuracy than miR-30d. Our findings suggest that elevated levels of miR-30d are associated with an increased rate of hospital readmission at both 3 months and 1 year after discharge. Larger, multicenter studies will be needed to confirm the validity of circulating miR-30d levels as a potential biomarker useful for risk prediction in ACPE patients and its utility in improving individualized patient care.
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Affiliation(s)
- Giordano Bianchi
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; (G.B.); (P.C.V.); (F.M.); (E.L.)
| | - Barbara Vizio
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (B.V.); (O.B.); (M.S.); (G.M.); (G.M.)
| | - Ornella Bosco
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (B.V.); (O.B.); (M.S.); (G.M.); (G.M.)
| | - Martina Schiavello
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (B.V.); (O.B.); (M.S.); (G.M.); (G.M.)
| | - Paolo Cagna Vallino
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; (G.B.); (P.C.V.); (F.M.); (E.L.)
- Residency Programme in Emergency Medicine, University of Turin, 10126 Turin, Italy
| | - Francesca Rumbolo
- Clinical Biochemistry Laboratory, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy;
| | - Fulvio Morello
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; (G.B.); (P.C.V.); (F.M.); (E.L.)
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (B.V.); (O.B.); (M.S.); (G.M.); (G.M.)
| | - Giulio Mengozzi
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (B.V.); (O.B.); (M.S.); (G.M.); (G.M.)
- Clinical Biochemistry Laboratory, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy;
| | - Giuseppe Montrucchio
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (B.V.); (O.B.); (M.S.); (G.M.); (G.M.)
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; (G.B.); (P.C.V.); (F.M.); (E.L.)
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (B.V.); (O.B.); (M.S.); (G.M.); (G.M.)
| | - Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; (G.B.); (P.C.V.); (F.M.); (E.L.)
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (B.V.); (O.B.); (M.S.); (G.M.); (G.M.)
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13
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Di Santo P, Abdel-Razek O, Prosperi-Porta G, Motazedian P, Thériault-Lauzier P, Alhassani S, Sterling LH, Parlow S, Mathieu ME, Jung RG, Morgan B, Coyle D, Fergusson DA, Kyeremanteng K, Mathew R, Labinaz M, Froeschl M, Hibbert R, Simard T, Bird JG, Wells GA, Hibbert B. Point-of-Care Ultrasound for the Detection of Vascular Access Site Complications-The ULTRASITCOM Study. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2025; 4:102516. [PMID: 40109711 PMCID: PMC11916795 DOI: 10.1016/j.jscai.2024.102516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 12/02/2024] [Accepted: 12/16/2024] [Indexed: 03/22/2025]
Abstract
Background Recent technological advancements have expanded access to ultrasound technology. Invasive cardiac procedures come with risks of vascular access complications, necessitating efficient detection methods for dangerous complications such as pseudoaneurysms. Current clinical practice has relied on physical examination, and often requires formal diagnostic imaging to diagnose these complications. The ULTRAsound Assessment of Access SITe COMplications study assessed the diagnostic accuracy of point-of-care ultrasound (POCUS) as an adjunct to physical examination for the detection of pseudoaneurysms following invasive cardiac procedures. Methods We conducted a single-center study that enrolled patients who underwent invasive cardiovascular procedures with suspected access site complications. Cardiology fellows were trained on the use of POCUS by a radiologist with expertise in vascular imaging. The primary outcome focused on the diagnostic odds ratio (DOR) of combined clinical and POCUS assessments compared to Doppler ultrasound or computed tomography. Results Among 111 participants, most were female (59.5%), with a mean age of 72.2 years, and with transfemoral access being most prevalent (67.6%). A total of 15 participants were found to have a pseudoaneurysm on formal diagnostic imaging. The combined clinical and POCUS assessments were highly sensitive and demonstrated superior DOR for detecting pseudoaneurysms compared to the physical examination alone (DOR 42.6 [95% CI, 34.6-50.6] vs 15.6 [95% CI, 11.7-19.5]; P < .01). Conclusions Point-of-care ultrasound is a highly sensitive tool for detecting pseudoaneurysms following invasive cardiovascular procedures. These findings suggest the potential integration of POCUS into routine practice, which could result in timely complication identification and management, thereby improving patient outcomes and reducing health care costs.
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Graeme Prosperi-Porta
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pascal Thériault-Lauzier
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiovascular Medicine, Stanford School of Medicine, Palo Alto, California
| | - Saad Alhassani
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lee H Sterling
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marie-Eve Mathieu
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Baylie Morgan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jared G Bird
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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14
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Tarras E, Khosla A, Heerdt PM, Singh I. Right Heart Failure in the Intensive Care Unit: Etiology, Pathogenesis, Diagnosis, and Treatment. J Intensive Care Med 2025; 40:119-136. [PMID: 38031338 DOI: 10.1177/08850666231216889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Right heart (RH) failure carries a high rate of morbidity and mortality. Patients who present with RH failure often exhibit complex aberrant cardio-pulmonary physiology with varying presentations. The treatment of RH failure almost always requires care and management from an intensivist. Treatment options for RH failure patients continue to evolve rapidly with multiple options available, including different pharmacotherapies and mechanical circulatory support devices that target various components of the RH circulatory system. An understanding of the normal RH circulatory physiology, treatment, and support options for the RH failure patients is necessary for all intensivists to improve outcomes. The purpose of this review is to provide clinical guidance on the diagnosis and management of RH failure within the intensive care unit setting, and to highlight the different pathophysiological manifestations of RH failure, its hemodynamics, and treatment options available at the disposal of the intensivist.
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Affiliation(s)
- Elizabeth Tarras
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Akhil Khosla
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Paul M Heerdt
- Department of Anesthesiology, Division of Applied Hemodynamics, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
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15
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Akçalı MA, Çınar S, Tekin KA, Mert RM, Erduhan S, Dinçer E, Altunöz Y, Aksu A, Akçalı E. Evaluation of urinary density as a biomarker for the diagnosis of acute heart failure. PeerJ 2025; 13:e18836. [PMID: 39850831 PMCID: PMC11756357 DOI: 10.7717/peerj.18836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 12/18/2024] [Indexed: 01/25/2025] Open
Abstract
Background Heart failure (HF) has become a public healthcare concern with significant costs to countries because of the aging world population. Acute heart failure (AHF) is a common condition faced frequently in emergency departments, and patients often present to hospitals with complaints of breathlessness. The patient must be evaluated with anamnesis, physical examination, blood, and imaging results to diagnose AHF. Brain natriuretic peptide (BNP) is a widely accepted biomarker for the diagnosis of HF. Methods The files of the patients who applied to the emergency department with complaints of breathlessness were scanned, and BNP and urinary density (UD) levels were evaluated for the diagnosis of HF in patients. Results The results support that BNP is an effective biomarker in AHF, as is widely accepted. When the correlation between BNP and UD measurements was examined in the present study, a negative correlation was detected between the parameters. The results also suggested that low UD values may help diagnose AHF. Conclusion If similar results are obtained in prospective multicenter studies with the participation of more patients, UD value can be used as a biomarker for the diagnosis of AHF.
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Affiliation(s)
- Mustafa Ahmet Akçalı
- Department of Emergency Medicine, Ministry of Health Dogubayazit Dr Yasar Eryilmaz State Hospital, Ağrı, Turkey
| | - Semih Çınar
- Department of Emergency Medicine, Tekirdag Dr. Ismail Fehmi Cumalioglu City Hospital, Tekirdağ, Turkey
| | - Kemal Abid Tekin
- Department of Cardiology, Ministry of Health Dogubayazit Dr Yasar Eryilmaz State Hospital, Ağrı, Turkey
| | - Recep Murat Mert
- Department of Emergency Medicine, Ministry of Health Dogubayazit Dr Yasar Eryilmaz State Hospital, Ağrı, Turkey
| | - Sena Erduhan
- Department of Medical Biochemistry, Dogubayazit Dr Yasar Eryilmaz State Hospital, Ağrı, Turkey
| | - Ertuğ Dinçer
- Department of Emergency Medicine, Ministry of Health Merzifon Kara Mustafa Pasa State Hospital, Amasya, Turkey
| | - Yusuf Altunöz
- Department of Emergency Medicine, Sincan Nafiz Korez Education and Research Hospital, Ankara, Turkey
| | - Arif Aksu
- Department of Emergency Medicine, Health Science University Adana City Research and Training Hospital, Adana, Turkey
| | - Esra Akçalı
- Department of Nephrology, Ministry of Health Tarsus State Hospital, Mersin, Turkey
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16
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Yaghoubi A, Heijl C, Khoshnood AM, Wändell PE, Carlsson AC, Wessman T. Association between endostatin and mortality in patients with acute dyspnoea, with or without congestive heart failure: a single-centre, prospective, observational study. BMJ Open 2025; 15:e085238. [PMID: 39800400 PMCID: PMC11752042 DOI: 10.1136/bmjopen-2024-085238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 12/02/2024] [Indexed: 01/24/2025] Open
Abstract
OBJECTIVE The aim of this study was to assess associations between endostatin levels and short-term mortality in unsorted acute hospitalised dyspnoea patients with or without congestive heart failure (CHF), adjusted for common cardiovascular risk factors. DESIGN, SETTING AND PARTICIPANTS In this prospective observational study, 723 hospitalised patients who visited the emergency department at Skåne University Hospital, Sweden, between 2013 and 2018 were included. Of these, 276 had a history of CHF. The association between endostatin levels and 1 month and 3-month mortality was evaluated, stratified by whether patients had a history of CHF or not. RESULTS Patients with prior CHF had higher endostatin levels, higher short-term mortality and were more likely to have CHF as discharge diagnosis. In a fully adjusted model, endostatin was independently associated with 3-month mortality (HR=1.01 per 1 ng/mL increment of endostatin; 95% CI 1.00 to 1.02; p=0.016). No evidence of association was identified with 1-month mortality. CONCLUSIONS Endostatins are potential biomarkers for 3 months' mortality in patients hospitalised with CHF seeking emergency care with acute dyspnoea. Further studies are needed in different settings to assess the predictive value of endostatins in patients with CHF.
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Affiliation(s)
| | - Caroline Heijl
- Department of Cardiology, Skåne University Hospital, Malmö, Skåne, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Skåne, Sweden
| | | | | | | | - Torgny Wessman
- Emergency Department, Skåne University Hospital, Malmo, Skåne, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Skåne, Sweden
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17
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Bouzidi H, Hammami S, Zairi I, Kammoun S, Kraiem S, Jabeur M, Gargouri R, Abid L. Role of pulmonary ultrasonography in diagnosis of acute heart failure. Curr Probl Cardiol 2025; 50:102910. [PMID: 39477175 DOI: 10.1016/j.cpcardiol.2024.102910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 10/27/2024] [Indexed: 11/03/2024]
Abstract
BACKGROUND One of the most prevalent causes of emergency room visits is acute dyspnea. Several etiologies, including cardiac, pulmonary, metabolic, psychogenic etc… may be involved. Acute heart failure (AHF) is among the most common causes. This study aims to evaluate, in patients presenting with acute dyspnea to the emergency departement (ED), the accuracy of a diagnostic approach combining Lung ultrasonography (LUS) and clinical assessment as compared to the traditional AHF diagnostic work-up. METHODS This is a bi-centric cross-sectional observational study, conducted at the Emergency and Cardiology Department of both the Hedi Chaker Hospital in Sfax and the Habib Thameur Hospital in Tunis for the period extending from 01/07/2022 to 30/09/2023. The diagnostic performance of pulmonary ultrasonography was studied and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared with those of clinical examination, chest X-Ray, NT-pro -BNP and the Transthoracic echocardiography (TTE) which was the reference exam. RESULTS The most common cause of acute dyspnea is acute heart failure (79.3 %). LUS had a sensitivity of 94,2 % in diagnosing AHF and a specificity of 77,5 %. Its PPV and NPV were respectively 92 % and 81 %. The area under curbe (AUC) of B-Lines required for the diagnosis of interstitial pulmonary syndrome was excellent (92 %). There was a moderate significant positive correlation between the number of B-Lines and NT-Pro-BNP levels r = 0.51, P < 0.001. Also, there was a very strong significant positive relationship between the pulmonary congestion assessed by LUS and Left atrium - pressure r = 0.788, P < 0.001 CONCLUSION: LUS is an excellent test both to confirm and exclude the diagnosis of AHF in patients consulting the emergency room for acute dyspnea and therefore deserves to be performed systematically.
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Affiliation(s)
- Hela Bouzidi
- Cardiology Department, Habib Thameur Hospital, Tunis 1008, Tunisia.
| | - Selim Hammami
- Cardiology Department, Habib Thameur Hospital, Tunis 1008, Tunisia.
| | - Ihsen Zairi
- Cardiology Department, Habib Thameur Hospital, Tunis 1008, Tunisia.
| | - Sofien Kammoun
- Cardiology Department, Habib Thameur Hospital, Tunis 1008, Tunisia.
| | - Sondos Kraiem
- Cardiology Department, Habib Thameur Hospital, Tunis 1008, Tunisia.
| | - Mariem Jabeur
- Cardiology Department, Hedi Chaker Hospital, Sfax 3000,Tunisia.
| | - Rania Gargouri
- Cardiology Department, Hedi Chaker Hospital, Sfax 3000,Tunisia.
| | - Leila Abid
- Cardiology Department, Hedi Chaker Hospital, Sfax 3000,Tunisia.
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18
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Gingele AJ, Beckers F, Boyne JJ, Brunner-La Rocca HP. Fluid status assessment in heart failure patients: pilot validation of the Maastricht Decompensation Questionnaire. Neth Heart J 2025; 33:7-13. [PMID: 39656355 PMCID: PMC11695504 DOI: 10.1007/s12471-024-01921-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND eHealth products have the potential to enhance heart failure (HF) care by identifying at-risk patients. However, existing risk models perform modestly and require extensive data, limiting their practical application in clinical settings. This study aims to address this gap by validating a more suitable risk model for eHealth integration. METHODS We developed the Maastricht Decompensation Questionnaire (MDQ) based on expert opinion to assess HF patients' fluid status using common signs and symptoms. Subsequently, the MDQ was administered to a cohort of HF outpatients at Maastricht University Medical Centre. Patients with ≥ 10 MDQ points were categorised as 'decompensated', patients with < 10 MDQ points as 'not decompensated'. HF nurses, blinded to MDQ scores, served as the gold standard for fluid status assessment. Patients were classified as 'correctly' if MDQ and nurse assessments aligned; otherwise, they were classified as 'incorrectly'. RESULTS A total of 103 elderly HF patients were included. The MDQ classified 50 patients as 'decompensated', with 17 of them being correctly classified (34%). Additionally, 53 patients were categorised as 'not decompensated', with 48 of them being correctly classified (90%). The calculated area under the curve was 0.69 (95% confidence interval: 0.57-0.81; p < 0.05). Cronbach's alpha reliability coefficient for the MDQ was 0.85. CONCLUSIONS The MDQ helps identify decompensated HF patients through clinical signs and symptoms. Further trials with larger samples are needed to confirm its validity, reliability and applicability. Tailoring the MDQ to individual patient profiles may improve its accuracy.
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Affiliation(s)
- Arno J Gingele
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Fabienne Beckers
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Josiane J Boyne
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Cucciolini G, Corradi F, Marrucci E, Ovesen SH. Basic Lung Ultrasound and Clinical Applications in General Medicine. Med Clin North Am 2025; 109:11-30. [PMID: 39567088 DOI: 10.1016/j.mcna.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2024]
Abstract
Proficiency in basic lung ultrasound is highly recommended for clinicians in general and internal medicine. This article will review and provide guidance for novice users on how to use lung ultrasound in clinical practice, through a pathology-oriented approach. The authors recommend a 12-zone protocol and describe how to perform and apply it in clinical practice while examining patients with clinical suspicion for the following diseases: pleural effusion, heart failure, pneumonia (bacterial and viral), interstitial lung disease, and pneumothorax.
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Affiliation(s)
- Giada Cucciolini
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Azienda Ospedaliero-Universitaria Pisana Cisanello, U/O Anestesia e Rianimazione Interdipartimentale, Via Paradisa 2, Pisa 56124, Italy
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Azienda Ospedaliero-Universitaria Pisana Cisanello, U/O Anestesia e Rianimazione Interdipartimentale, Via Paradisa 2, Pisa 56124, Italy
| | - Elena Marrucci
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Azienda Ospedaliero-Universitaria Pisana Cisanello, U/O Anestesia e Rianimazione Interdipartimentale, Via Paradisa 2, Pisa 56124, Italy
| | - Stig Holm Ovesen
- Department of Clinical Medicine, Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark; Emergency Department, Horsens Regional Hospital, Denmark.
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20
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Tariq MA, Malik MK, Khalid Z, Asrar A. Door-to-Diuretic Time and Short-term Outcomes in Acute Heart Failure: A Systematic Review and Meta-analysis. Crit Pathw Cardiol 2024; 23:175-182. [PMID: 38598546 DOI: 10.1097/hpc.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Acute heart failure (AHF) is a leading cause of unplanned hospitalization, often associated with poor outcomes. Decongestion with intravenous loop diuretics is the mainstay of treatment. Metrics such as door-to-diuretic time, the time between presentation of AHF to the hospital, and administration of intravenous diuretics, may play an important role in faster decongestion and thereby reduce mortality. We sought to investigate whether early diuretic administration [door-to-diuretic (D2D) time 60 ≤mins] was associated with improved outcomes among hospitalized heart failure patients. METHODS A systematic search of PubMed and Scopus databases was performed from inception until June 2023. The primary endpoints were all-cause in-hospital and 30-day mortality. Secondary endpoints were the length of hospital stay and heart failure readmission. We used a random-effects model to calculate odds ratios (OR) for binary outcomes and mean differences for continuous data. RESULTS Our meta-analysis included 6 observational studies involving 19,916 patients. No significant differences ( P > 0.05) were observed between shorter D2D and delayed D2D time with respect to in-hospital mortality (OR, 0.62; 95% CI, 0.35-1.09), 30-day mortality (OR, 0.83; 95% CI, 0.51-1.33; P = 0.44), length of hospital stay (MD, -0.02; 95% CI, -0.26 to 0.22) and heart failure readmission (OR, 1.00; 95% CI, 0.86-1.20). CONCLUSIONS Evidence from existing literature, which is largely limited to observational comparisons, highlights comparable outcomes between the 2 treatment strategies. Early diuretic administration, particularly within 60 minutes of hospital presentation, does not demonstrate any prognostic benefits.
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Affiliation(s)
- Muhammad Ali Tariq
- From the Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Minhail Khalid Malik
- From the Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Zoha Khalid
- From the Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Aeman Asrar
- Arnot Ogden Medical Center, Arnot Health, New York, NY
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21
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Gottlieb M, Moyer E, Bernard K. Epidemiology of heart failure presentations to United States emergency departments from 2016 to 2023. Am J Emerg Med 2024; 86:70-73. [PMID: 39366035 DOI: 10.1016/j.ajem.2024.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/20/2024] [Accepted: 09/22/2024] [Indexed: 10/06/2024] Open
Abstract
INTRODUCTION Heart failure (HF) is a common condition prompting presentation to the Emergency Department (ED) and is associated with significant morbidity and mortality. However, there is limited recent large-scale, robust data available on the admission rates, evaluation, and treatment of HF in the ED setting. METHODS This was a cross-sectional study of ED presentations for HF from 1/1/2016 to 12/31/2023 using the Epic Cosmos database. All ED visits with ICD-10 codes corresponding to acute HF were included. We excluded congenital heart disease and isolated right-sided HF. Outcomes included percentage of total ED visits, admission rates, troponin, B-type natriuretic peptide (BNP), chest radiography, and diuretic and nitroglycerin medication administration. Subgroup analyses of medications were performed by medication and route of administration (transdermal, sublingual/oral, and intravenous). RESULTS Out of 190,694,752 ED encounters, 2,626,011 (1.4 %) visits were due to acute HF. Of these, 1,897,369 (72.3 %) were admitted to the hospital. The majority of patients had a troponin (90.3 %), BNP (91.1 %), and chest radiograph (89.5 %) ordered. 82.5 % received intravenous diuresis, while 46.2 % received oral diuresis. The most common diuretic was furosemide (78.4 % intravenous, 32.5 % oral), followed by bumetanide (9.5 % intravenous, 7.1 % oral), and torsemide (0 % intravenous, 8.1 % oral). Nitroglycerin was given in 26.0 %, with the most common route being sublingual/oral (16.6 %), followed by transdermal (9.2 %) and intravenous (3.5 %). CONCLUSION HF represents a common reason for ED presentation, with the majority of patients being admitted. All patients received diuresis in the ED, with the majority receiving intravenous diuresis with furosemide. Approximately one-quarter received nitroglycerin with the sublingual/oral route being most common. These findings can help inform health policy initiatives, including admission decisions and evidence-based medication administration.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Eric Moyer
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kyle Bernard
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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22
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Assavapokee T, Rola P, Assavapokee N, Koratala A. Decoding VExUS: a practical guide for excelling in point-of-care ultrasound assessment of venous congestion. Ultrasound J 2024; 16:48. [PMID: 39560910 PMCID: PMC11576717 DOI: 10.1186/s13089-024-00396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 10/18/2024] [Indexed: 11/20/2024] Open
Abstract
Venous congestion, often associated with elevated right atrial pressure presents a clinical challenge due to its varied manifestations and potential organ damage. Recognizing the manifestations of venous congestion through bedside physical examination or laboratory tests can be challenging. Point-of-care ultrasound (POCUS) is emerging as a valuable bedside tool for assessing venous congestion, with the Venous Excess Ultrasound (VExUS) technique gaining prominence. VExUS facilitates non-invasive quantification of venous congestion, relying on measurements of the inferior vena cava (IVC) size and Doppler assessments of the hepatic vein (HV), portal vein (PV), and intrarenal vein, thereby providing real-time insights into hemodynamic status and guiding therapeutic interventions. The grading system outlined in VExUS aids in stratifying the severity of congestion. However, achieving proficiency in VExUS requires a comprehensive understanding of Doppler techniques and their clinical applications. This review article provides practical guidance on performing VExUS, encompassing equipment requirements, preparation, machine settings, and examination techniques for assessing the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV), and intrarenal vein. Potential pitfalls and troubleshooting strategies are discussed to ensure accurate interpretation of Doppler waveforms.
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Affiliation(s)
- Taweevat Assavapokee
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Philippe Rola
- Division of Intensive Care, Santa Cabrini Hospital, Montreal, QC, Canada
| | - Nicha Assavapokee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
| | - Abhilash Koratala
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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23
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Peschanski N, Zores F, Boddaert J, Douay B, Delmas C, Broussier A, Douillet D, Berthelot E, Gilbert T, Gil-Jardiné C, Auffret V, Joly L, Guénézan J, Galinier M, Pépin M, Le Borgne P, Le Conte P, Girerd N, Roca F, Oberlin M, Jourdain P, Rousseau G, Lamblin N, Villoing B, Mouquet F, Dubucs X, Roubille F, Jonchier M, Sabatier R, Laribi S, Salvat M, Chouihed T, Bouillon-Minois JB, Chauvin A. 2023 SFMU/GICC-SFC/SFGG expert recommendations for the emergency management of older patients with acute heart failure. Part 1: Prehospital management and diagnosis. Arch Cardiovasc Dis 2024; 117:639-646. [PMID: 39261191 DOI: 10.1016/j.acvd.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/13/2024] [Accepted: 08/19/2024] [Indexed: 09/13/2024]
Affiliation(s)
- Nicolas Peschanski
- Emergency Department, University of Rennes, CHU de Rennes, 35000 Rennes, France.
| | | | - Jacques Boddaert
- Department of Geriatrics, Hôpital Pitié-Salpêtrière, Sorbonne University, AP-HP, 75013 Paris, France
| | - Bénedicte Douay
- Emergency Department, Hôpital Beaujon, AP-HP, 92110 Clichy, France
| | - Clément Delmas
- Inserm I2MC, UMR 1048, Cardiology A Department, Université UPS, CHU de Toulouse, 31000 Toulouse, France
| | - Amaury Broussier
- Inserm, Department of Geriatrics, Hôpitaux Henri-Mondor/Émile Roux, AP-HP, University Paris-Est Créteil, IMRB, 94456 Limeil-Brevannes, France
| | - Delphine Douillet
- UMR MitoVasc CNRS 6015, Inserm 1083, FCRIN, INNOVTE, Emergency Department, University of Angers, CHU d'Angers, 49000 Angers, France
| | - Emmanuelle Berthelot
- Cardiology Department, Hôpital Bicêtre, Université Paris-Saclay, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - Thomas Gilbert
- RESHAPE, Inserm U1290, Department of Geriatric Medicine, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - Cédric Gil-Jardiné
- Inserm, Centre Inserm U1219-EBEP, ISPED, Emergency Department, Pellegrin Hospital, University Hospital of Bordeaux, 33000 Bordeaux, France
| | | | - Laure Joly
- Inserm, Geriatric Department, DCAC, CHRU de Nancy, Université de Lorraine, 54000 Vandœuvre-Lès-Nancy, France
| | - Jérémy Guénézan
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, 86000 Poitiers, France
| | - Michel Galinier
- Inserm I2MC, UMR 1048, Cardiology A Department, Université UPS, CHU de Toulouse, 31000 Toulouse, France
| | - Marion Pépin
- Department of Geriatrics, Ambroise-Paré Hospital, GHU, AP-HP, 92100 Boulogne-Billancourt, France; Inserm, Clinical Epidemiology Department, University of Paris-Saclay, UVSQ, 94800 Villejuif, France
| | - Pierrick Le Borgne
- Service d'accueil des Urgences, Hôpital de Hautepierre, CHU de Strasbourg, 67000 Strasbourg, France
| | | | - Nicolas Girerd
- Cardiology Department, CHRU de Nancy, 54000 Vandœuvre-lès-Nancy, France
| | - Frédéric Roca
- Inserm U1096, UNIROUEN, Department of Geriatric Medicine, Rouen University Hospital, Normandy University, 76000 Rouen, France
| | - Mathieu Oberlin
- Emergency Department, Groupe Hospitalier Sélestat-Obernai, 67600 Sélestat, France
| | - Patrick Jourdain
- Cardiology Department, Hôpital Bicêtre, Université Paris-Saclay, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | | | - Nicolas Lamblin
- Cardiology Department, Hôpital Cardiologique, Centre de Compétence de l'Hypertension Artérielle Pulmonaire Sévère, Université Lille Nord de France, CHRU de Lille, 59000 Lille, France
| | - Barbara Villoing
- Emergency Department, Hôpital Cochin-Hôtel-Dieu, AP-HP, 75014 Paris, France
| | - Frédéric Mouquet
- Department of Cardiology, Hôpital privé Le Bois, 59000 Lille, France
| | - Xavier Dubucs
- Emergency Department, CHU de Toulouse, 31000 Toulouse, France
| | - François Roubille
- Inserm, CNRS, PhyMedExp, Department of Cardiology, Montpellier University Hospital, Université de Montpellier, 34295 Montpellier, France
| | - Maxime Jonchier
- Emergency Department, Groupe Hospitalier Littoral Atlantique, 17019 La Rochelle, France
| | - Rémi Sabatier
- Cardiovascular Department, University of Caen-Normandie, CHU de Caen-Normandie, 14000 Caen, France
| | - Saïd Laribi
- Urgences SAMU37 SMUR de Tours, Centre Hospitalier Régional et Universitaire Tours, 37000 Tours, France
| | - Muriel Salvat
- Department of Cardiology, University Hospital, Grenoble-Alpes, 38000 Grenoble, France
| | - Tahar Chouihed
- Inserm, UMR_S 1116, Emergency Department, University Hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France
| | - Jean-Baptiste Bouillon-Minois
- CNRS, LaPSCo, Physiological and Psychosocial Stress, Emergency Medicine Department, Université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, AP-HP, 75010 Paris, France
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Wang Q, Zou T, Zeng X, Bao T, Yin W. Establishment of seven lung ultrasound phenotypes: a retrospective observational study of an LUS registry. BMC Pulm Med 2024; 24:483. [PMID: 39363211 PMCID: PMC11450992 DOI: 10.1186/s12890-024-03299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 09/19/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Lung phenotypes have been extensively utilized to assess lung injury and guide precise treatment. However, current phenotypic evaluation methods rely on CT scans and other techniques. Although lung ultrasound (LUS) is widely employed in critically ill patients, there is a lack of comprehensive and systematic identification of LUS phenotypes based on clinical data and assessment of their clinical value. METHODS Our study was based on a retrospective database. A total of 821 patients were included from September 2019 to October 2020. 1902 LUS examinations were performed in this period. Using a dataset of 55 LUS examinations focused on lung injuries, a group of experts developed an algorithm for classifying LUS phenotypes based on clinical practice, expert experience, and lecture review. This algorithm underwent validation and refinement with an additional 140 LUS images, leading to five iterative revisions and the generation of 1902 distinct LUS phenotypes. Subsequently, a validated machine learning algorithm was applied to these phenotypes. To assess the algorithm's effectiveness, experts manually verified 30% of the phenotypes, confirming its efficacy. Using K-means cluster analysis and expert image selection from the 1902 LUS examinations, we established seven distinct LUS phenotypes. To further explore the diagnostic value of these phenotypes for clinical diagnosis, we investigated their auxiliary diagnostic capabilities. RESULTS A total of 1902 LUS phenotypes were tested by randomly selecting 30% to verify the phenotypic accuracy. With the 1902 LUS phenotypes, seven lung ultrasound phenotypes were established through statistical K-means cluster analysis and expert screening. The acute respiratory distress syndrome (ARDS) exhibited gravity-dependent phenotypes, while the cardiogenic pulmonary edema exhibited nongravity phenotypes. The baseline characteristics of the 821 patients included age (66.14 ± 11.76), sex (560/321), heart rate (96.99 ± 23.75), mean arterial pressure (86.5 ± 13.57), Acute Physiology and Chronic Health Evaluation II (APACHE II)score (20.49 ± 8.60), and duration of ICU stay (24.50 ± 26.22); among the 821 patients, 78.8% were cured. In severe pneumonia patients, the gravity-dependent phenotype accounted for 42% of the cases, whereas the nongravity-dependent phenotype constituted 58%. These findings highlight the value of applying different LUS phenotypes in various diagnoses. CONCLUSIONS Seven sets of LUS phenotypes were established through machine learning analysis of retrospective data; these phenotypes could represent the typical characteristics of patients with different types of critical illness.
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Affiliation(s)
- Qian Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, 610081, China
| | - Tongjuan Zou
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
- Visualization Diagnosis and Treatment & Artificial Intelligence Laboratory, Institute of Critical Care Medicine Research, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Xueying Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
- Visualization Diagnosis and Treatment & Artificial Intelligence Laboratory, Institute of Critical Care Medicine Research, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Ting Bao
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China.
- Visualization Diagnosis and Treatment & Artificial Intelligence Laboratory, Institute of Critical Care Medicine Research, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China.
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Lee CK, Chen TL, Wu JE, Liao MT, Wang C, Wang W, Chou CY. Multimodal deep learning models utilizing chest X-ray and electronic health record data for predictive screening of acute heart failure in emergency department. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108357. [PMID: 39126913 DOI: 10.1016/j.cmpb.2024.108357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Ambiguity in diagnosing acute heart failure (AHF) leads to inappropriate treatment and potential side effects of rescue medications. To address this issue, this study aimed to use multimodality deep learning models combining chest X-ray (CXR) and electronic health record (EHR) data to screen patients with abnormal N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in emergency departments. METHODS Using the open-source dataset MIMIC-IV and MIMICCXR, the study population consisted of 1,432 patients and 1,833 pairs of CXRs and EHRs. We processed the CXRs, extracted relevant features through lung-heart masks, and combined these with the vital signs at triage to predict corresponding NT-proBNP levels. RESULTS The proposed method achieved a 0.89 area under the receiver operating characteristic curve by fusing predictions from single-modality models of heart size ratio, radiomic features, CXR, and the region of interest in the CXR. The model can accurately predict dyspneic patients with abnormal NT-proBNP concentrations, allowing physicians to reduce the risks associated with inappropriate treatment. CONCLUSION The study provided new image features related to AHF and offered insights into future research directions. Overall, these models have great potential to improve patient outcomes and reduce risks in emergency departments.
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Affiliation(s)
- Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Ln. 442, Sec. 1, Jingguo Rd., Hsinchu 300, Taiwan, ROC
| | - Ting-Li Chen
- Institute of Statistical Science, Academia Sinica, 128 Academia Rd., Nankang, Taipei 11529, Taiwan, ROC
| | - Jeng-En Wu
- Master Program in Statistics, National Taiwan University, 1, Sec. 4 Roosevelt Rd., Taipei 106, Taiwan, ROC
| | - Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Ln. 442, Sec. 1, Jingguo Rd., Hsinchu 300, Taiwan, ROC
| | - Chiehhung Wang
- Data Science Degree Program, National Taiwan University, 1, Sec. 4 Roosevelt Rd., Taipei 106, Taiwan, ROC
| | - Weichung Wang
- Institute of Applied Mathematical Sciences, National Taiwan University, 1, Sec. 4 Roosevelt Rd., Taipei 106, Taiwan, ROC.
| | - Cheng-Ying Chou
- Master Program in Statistics, National Taiwan University, 1, Sec. 4 Roosevelt Rd., Taipei 106, Taiwan, ROC; Department of Biomechatronics Engineering, National Taiwan University, 1, Sec. 4 Roosevelt Rd., Taipei, 106, Taiwan, ROC.
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26
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Dojcinovic B, Banjac N, Vukmirovic S, Dojcinovic T, Vasovic LV, Mihajlovic D, Vasovic V. The LUSBI Protocol (Lung Ultrasound/BREST Score/Inferior Vena Cava)-Its Role in a Differential Diagnostic Approach to Dyspnea of Cardiogenic and Non-Cardiogenic Origin. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1521. [PMID: 39336562 PMCID: PMC11433694 DOI: 10.3390/medicina60091521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/04/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: PoCUS ultrasound applications are widely used in everyday work, especially in the field of emergency medicine. The main goal of this research was to create a diagnostic and therapeutic protocol that will integrate ultrasound examination of the lungs, ultrasound measurements of the inferior vena cava (assessment of central venous pressure) and BREST scores (risk stratification for heart failure), with the aim of establishing a more effective differential diagnostic approach for dyspneic patients. Materials and Methods: A cross-sectional study was conducted in the emergency medicine department with the educational center of the community health center of Banja Luka. Eighty patients of both sexes were included and divided into experimental and control groups based on the presence or absence of dyspnea as a dominant subjective complaint. Based on the abovementioned variables, the LUSBI protocol (lung ultrasound/BREST score/inferior vena cava) was created, including profiles to determine the nature of the origin of complaints. The biochemical marker of heart failure NT pro-BNP served as a laboratory confirmation of the cardiac origin of the complaints. Results: The distribution of NT pro BNP values in the experimental group showed statistically significant differences between individual profiles of the LUSBI protocol (p < 0.001). Patients assigned to group B PLAPS 2 had significantly higher average values of NT pro-BNP (20159.00 ± 3114.02 pg/mL) compared to other LUSBI profiles. Patients from the experimental group who had a high risk of heart failure according to their BREST scores also had a significantly higher average maximum expiratory diameter compared to those without heart failure (p = 0.004). A statistically significant difference (p = 0.001) in LUSBI profiles was observed between the groups of patients divided according to CVP categories. Conclusion: The integration of the LUSBI protocol into the differential diagnosis of dyspnea has been shown to be very effective in confirming or excluding a cardiac cause of the disease in patients.
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Affiliation(s)
- Boris Dojcinovic
- Emergency Medical Service of Primary Health Care Center in Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Medical Faculty, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Nada Banjac
- Emergency Medical Service of Primary Health Care Center in Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Medical Faculty, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Sasa Vukmirovic
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Tamara Dojcinovic
- Medical Faculty, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Internal Medicine Clinic, University Clinical Center of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Lucija V Vasovic
- Institute for Pulmonary Diseases of Vojvodina, 21000 Novi Sad, Serbia
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Dalibor Mihajlovic
- Emergency Medical Service of Primary Health Care Center in Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Medical Faculty, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Velibor Vasovic
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
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Yamada H, Ohara T, Abe Y, Iwano H, Onishi T, Katabami K, Takigiku K, Tada A, Tanigushi H, Mihara H, Yamamoto T, Maeda K, Wada Y. Guidance for performance, utilization, and education of cardiac and lung point-of-care ultrasonography from the Japanese Society of Echocardiography. J Echocardiogr 2024; 22:113-151. [PMID: 38722468 DOI: 10.1007/s12574-024-00649-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 08/24/2024]
Abstract
In recent years, bedside ultrasound examinations have been used in many clinical departments and are called point-of-care ultrasound (POCUS). Regarding POCUS in the cardiac field, a protocol called focus (focused) cardiac ultrasound (FoCUS) has been developed in Europe and the United States, is being used clinically, and an educational syllabus has been created. According to them, FoCUS is defined as a point-of-care cardiac ultrasound examination using standardized limited sections and protocols. FoCUS is primarily intended to be performed by non-cardiologists, and in order to avoid making mistakes in judgment, it is important to be familiar with its limitations and it is necessary to understand pathological conditions that can only be diagnosed using conventional comprehensive echocardiography. The Japanese Society of Echocardiography has edited this clinical guideline because we believe that FoCUS should be used effectively and appropriately in Japan, and that appropriate education is essential to popularize FoCUS in Japan. Furthermore, lung POCUS has recently come into clinical use. Lung POCUS is useful for the diagnosis and follow-up of heart failure when used in conjunction with FoCUS, and is especially useful in primary care where chest X-rays are not available. The working group that created this manual agreed that it is desirable to educate patients about lung POCUS in conjunction with FoCUS, so we decided to include the basic techniques of lung POCUS and how to use them in this manuscript.
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Affiliation(s)
- Hirotsugu Yamada
- Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - Takahiro Ohara
- Division of Geriatric and Community Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yukio Abe
- Cardiovascular Medicine, Cardiovascular Center, Osaka City General Hospital, Osaka, Japan
| | - Hiroyuki Iwano
- Division of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tetsuari Onishi
- Cardiovascular Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Kenichi Katabami
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Akira Tada
- Department of Internal Medicine, National Health Insurance Kuniyoshi/Hasekebara Clinic, Nara, Japan
| | - Hayato Tanigushi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Nippon, Japan
| | - Ken Maeda
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yasuaki Wada
- Cardiovascular Medicine, Nagoya City University East Medical Center, Nagoya, Japan
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Ovesen SH, Skaarup SH, Aagaard R, Kirkegaard H, Løfgren B, Arvig MD, Bibby BM, Posth S, Laursen CB, Weile J. Effect of a Point-of-Care Ultrasound-Driven vs Standard Diagnostic Pathway on 24-Hour Hospital Stay in Emergency Department Patients with Dyspnea-Protocol for A Randomized Controlled Trial. Open Access Emerg Med 2024; 16:211-219. [PMID: 39221420 PMCID: PMC11365495 DOI: 10.2147/oaem.s454062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose Point-of-care ultrasound (POCUS) helps emergency department (ED) physicians make prompt and appropriate decisions, but the optimal diagnostic integration and potential clinical benefits remain unclear. We describe the protocol and statistical analysis plan for a randomized controlled trial. The objective is to determine the effect of a POCUS-driven diagnostic pathway in adult dyspneic ED patients on the proportion of patients having a hospital stay of less than 24 hours when compared to the standard diagnostic pathway. Patients and Methods This is a multicenter, randomized, investigator-initiated, open-labeled, pragmatic, controlled trial. Adult ED patients with chief complaint dyspnea are eligible. Patients are randomized (1:1) to the POCUS-driven diagnostic pathway or standard diagnostic pathway, with 337 patients in each group. The primary outcome is the proportion of patients having a hospital stay (from ED arrival to hospital discharge) of less than 24 hours. Key secondary outcomes include hospital length-of-stay, 72-hour revisits, and 30-day hospital-free days. Conclusion Sparse evidence exists for any clinical benefit from a POCUS-integrated diagnostic pathway. The results from this trial will help clarify the promising signals for POCUS to influence patient care among ED patients with dyspnea.
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Affiliation(s)
- Stig Holm Ovesen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Emergency Department, Horsens Regional Hospital, Horsens, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Rasmus Aagaard
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Michael Dan Arvig
- Emergency Department, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bo Martin Bibby
- Department of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Stefan Posth
- Emergency Department, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Weile
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Emergency Department, Horsens Regional Hospital, Horsens, Denmark
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Okafor J, Blodgett M. Comment on 'Acute heart failure in elderly patients admitted to the emergency department with acute dyspnea: a multimarker approach diagnostic study'. Eur J Emerg Med 2024; 31:297. [PMID: 38934076 DOI: 10.1097/mej.0000000000001112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Affiliation(s)
| | - Maxwell Blodgett
- Department of Emergency Medicine, Christiana Hospital
- ChristianaCare Emergency Medicine, Newark, Delaware
- Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Balen F, Lamy S, Froissart L, Mesnard T, Sanchez B, Dubucs X, Charpentier S. Risk factors and effect of dyspnea inappropriate treatment in adults' emergency department: a retrospective cohort study. Eur J Emerg Med 2024; 31:276-280. [PMID: 38364038 DOI: 10.1097/mej.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Dyspnea is a frequent symptom in adults' emergency departments (EDs). Misdiagnosis at initial clinical examination is common, leading to early inappropriate treatment and increased in-hospital mortality. Risk factors of inappropriate treatment assessable at early examination remain undescribed herein. The objective of this study was to identify clinical risk factors of dyspnea and inappropriate treatment in patients admitted to ED. This is an observational retrospective cohort study. Patients over the age of 15 who were admitted to adult EDs of the University Hospital of Toulouse (France) with dyspnea were included from 1 July to 31 December 2019. The primary end-point was dyspnea and inappropriate treatment was initiated at ED. Inappropriate treatment was defined by looking at the final diagnosis of dyspnea at hospital discharge and early treatment provided. Afterward, this early treatment at ED was compared to the recommended treatment defined by the International Guidelines for Acute Heart Failure, bacterial pneumonia, chronic obstructive pulmonary disease, asthma or pulmonary embolism. A total of 2123 patients were analyzed. Of these, 809 (38%) had inappropriate treatment in ED. Independent risk factors of inappropriate treatment were: age over 75 years (OR, 1.46; 95% CI, 1.18-1.81), history of heart disease (OR, 1.32; 95% CI, 1.07-1.62) and lung disease (OR, 1.47; 95% CI, 1.21-1.78), SpO 2 <90% (OR, 1.64; 95% CI, 1.37-2.02), bilateral rale (OR, 1.25; 95% CI, 1.01-1.66), focal cracklings (OR, 1.32; 95% CI, 1.05-1.66) and wheezing (OR, 1.62; 95% CI, 1.31-2.03). In multivariate analysis, under-treatment significantly increased in-hospital mortality (OR, 2.13; 95% CI, 1.29-3.52) compared to appropriate treatment. Over-treatment nonsignificantly increased in-hospital mortality (OR, 1.43; 95% CI, 0.99-2.06). Inappropriate treatment is frequent in patients admitted to ED for dyspnea. Patients older than 75 years, with comorbidities (heart or lung disease), hypoxemia (SpO 2 <90%) or abnormal pulmonary auscultation (especially wheezing) are at risk of inappropriate treatment.
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Affiliation(s)
- Frederic Balen
- Emergency Department, Toulouse University Hospital
- CERPOP - EQUITY, INSERM
| | | | | | | | | | - Xavier Dubucs
- Emergency Department, Toulouse University Hospital
- CERPOP - EQUITY, INSERM
- Toulouse III - Paul Sabatier University, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital
- CERPOP - EQUITY, INSERM
- Toulouse III - Paul Sabatier University, Toulouse, France
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Lajili F, Toumia M, Sekma A, Bel Haj Ali K, Sassi S, Zorgati A, Yaakoubi H, Youssef R, Grissa MH, Beltaief K, Mezgar Z, Khrouf M, Chamtouri I, Bouida W, Boubaker H, Msolli MA, Dridi Z, Boukef R, Nouira S. Value of Lung Ultrasound Sonography B-Lines Quantification as a Marker of Heart Failure in COPD Exacerbation. Int J Chron Obstruct Pulmon Dis 2024; 19:1767-1774. [PMID: 39108664 PMCID: PMC11300558 DOI: 10.2147/copd.s447819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/07/2024] [Indexed: 01/31/2025] Open
Abstract
Introduction Identifying heart failure (HF) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can be challenging. Lung ultrasound sonography (LUS) B-lines quantification has recently gained a large place in the diagnosis of HF, but its diagnostic performance in AECOPD remains poorly studied. Purpose This study aimed to assess the contribution of LUS B-lines score (LUS score) in the diagnosis of HF in AECOPD patients. Patients and methods This is a prospective cross-sectional multicenter cohort study including patients admitted to the emergency department for AECOPD. All included patients underwent LUS. A lung ultrasound score (LUS score) based on B-lines calculation was assessed. A cardiac origin of dyspnea was retained for a LUS score greater than 15. HF diagnosis was based on clinical examination, pro-brain natriuretic peptide levels, and echocardiographic findings. The LUS score diagnostic performance was assessed by receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio at the best cutoffs. Results We included 380 patients, mean age was 68±11.6 years, sex ratio (M/F) 1.96. Patients were divided into two groups: the HF group [n=157 (41.4%)] and the non-HF group [n=223 (58.6%)]. Mean LUS score was higher in the HF group (26.8±8.4 vs 15.3±7.1; p<0.001). The mean LUS score in the HF patients with reduced LVEF was 29.2±8.7, and was 24.5±7.6 in the HF patients with preserved LVEF. LUS score area under ROC curve for the diagnosis of HF was 0.71 [0.65-0.76]. The best sensitivity (89% [85.9-92,1]) was observed at the threshold of 5; the best specificity (85% [81.4-88.6]) was observed at the threshold of 30. Correlation between LUS score and E/E' ratio was good (R=0.46, p=0.0001). Conclusion Our results suggest that LUS score could be helpful and should be considered in the diagnostic approach of HF in AECOPD patients, at least as a ruling in test.
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Affiliation(s)
- Fadwa Lajili
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Marwa Toumia
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Adel Sekma
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Khaoula Bel Haj Ali
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Sarra Sassi
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, 4011, Tunisia
| | - Hajer Yaakoubi
- Emergency Department, Sahloul University Hospital, Sousse, 4011, Tunisia
| | - Rym Youssef
- Emergency Department, Sahloul University Hospital, Sousse, 4011, Tunisia
| | - Mohamed Habib Grissa
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Kaouther Beltaief
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Zied Mezgar
- Emergency Department, Farhat Hached University Hospital, Sousse, 4031, Tunisia
| | - Mariem Khrouf
- Emergency Department, Farhat Hached University Hospital, Sousse, 4031, Tunisia
| | - Ikram Chamtouri
- Department of Cardiology B, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Wahid Bouida
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Hamdi Boubaker
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Mohamed Amine Msolli
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Zohra Dridi
- Department of Cardiology A, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, 4011, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
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Torres Macho J, Duffot Falcó M. [Ultrasound assessment of the inferior vena cava in heart failure]. Med Clin (Barc) 2024; 163:78-80. [PMID: 38580571 DOI: 10.1016/j.medcli.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Juan Torres Macho
- Unidad de Ecografía Clínica, Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de La Torre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España.
| | - Mercedes Duffot Falcó
- Unidad de Ecografía Clínica, Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de La Torre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
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Awasthy R, Malhotra M, Seavers ML, Newman M. Admission prioritization of heart failure patients with multiple comorbidities. Front Digit Health 2024; 6:1379336. [PMID: 39015480 PMCID: PMC11250659 DOI: 10.3389/fdgth.2024.1379336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/23/2024] [Indexed: 07/18/2024] Open
Abstract
The primary objective of this study was to enhance the operational efficiency of the current healthcare system by proposing a quicker and more effective approach for healthcare providers to deliver services to individuals facing acute heart failure (HF) and concurrent medical conditions. The aim was to support healthcare staff in providing urgent services more efficiently by developing an automated decision-support Patient Prioritization (PP) Tool that utilizes a tailored machine learning (ML) model to prioritize HF patients with chronic heart conditions and concurrent comorbidities during Urgent Care Unit admission. The study applies key ML models to the PhysioNet dataset, encompassing hospital admissions and mortality records of heart failure patients at Zigong Fourth People's Hospital in Sichuan, China, between 2016 and 2019. In addition, the model outcomes for the PhysioNet dataset are compared with the Healthcare Cost and Utilization Project (HCUP) Maryland (MD) State Inpatient Data (SID) for 2014, a secondary dataset containing heart failure patients, to assess the generalizability of results across diverse healthcare settings and patient demographics. The ML models in this project demonstrate efficiencies surpassing 97.8% and specificities exceeding 95% in identifying HF patients at a higher risk and ranking them based on their mortality risk level. Utilizing this machine learning for the PP approach underscores risk assessment, supporting healthcare professionals in managing HF patients more effectively and allocating resources to those in immediate need, whether in hospital or telehealth settings.
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Affiliation(s)
- Rahul Awasthy
- Data Science, Harrisburg University of Science and Technology, Harrisburg, PA, United States
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Rudolph J, Huemmer C, Preuhs A, Buizza G, Hoppe BF, Dinkel J, Koliogiannis V, Fink N, Goller SS, Schwarze V, Mansour N, Schmidt VF, Fischer M, Jörgens M, Ben Khaled N, Liebig T, Ricke J, Rueckel J, Sabel BO. Nonradiology Health Care Professionals Significantly Benefit From AI Assistance in Emergency-Related Chest Radiography Interpretation. Chest 2024; 166:157-170. [PMID: 38295950 PMCID: PMC11251081 DOI: 10.1016/j.chest.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Chest radiographs (CXRs) are still of crucial importance in primary diagnostics, but their interpretation poses difficulties at times. RESEARCH QUESTION Can a convolutional neural network-based artificial intelligence (AI) system that interprets CXRs add value in an emergency unit setting? STUDY DESIGN AND METHODS A total of 563 CXRs acquired in the emergency unit of a major university hospital were retrospectively assessed twice by three board-certified radiologists, three radiology residents, and three emergency unit-experienced nonradiology residents (NRRs). They used a two-step reading process: (1) without AI support; and (2) with AI support providing additional images with AI overlays. Suspicion of four suspected pathologies (pleural effusion, pneumothorax, consolidations suspicious for pneumonia, and nodules) was reported on a five-point confidence scale. Confidence scores of the board-certified radiologists were converted into four binary reference standards of different sensitivities. Performance by radiology residents and NRRs without AI support/with AI support were statistically compared by using receiver-operating characteristics (ROCs), Youden statistics, and operating point metrics derived from fitted ROC curves. RESULTS NRRs could significantly improve performance, sensitivity, and accuracy with AI support in all four pathologies tested. In the most sensitive reference standard (reference standard IV), NRR consensus improved the area under the ROC curve (mean, 95% CI) in the detection of the time-critical pathology pneumothorax from 0.846 (0.785-0.907) without AI support to 0.974 (0.947-1.000) with AI support (P < .001), which represented a gain of 30% in sensitivity and 2% in accuracy (while maintaining an optimized specificity). The most pronounced effect was observed in nodule detection, with NRR with AI support improving sensitivity by 53% and accuracy by 7% (area under the ROC curve without AI support, 0.723 [0.661-0.785]; with AI support, 0.890 [0.848-0.931]; P < .001). Radiology residents had smaller, mostly nonsignificant gains in performance, sensitivity, and accuracy with AI support. INTERPRETATION We found that in an emergency unit setting without 24/7 radiology coverage, the presented AI solution features an excellent clinical support tool to nonradiologists, similar to a second reader, and allows for a more accurate primary diagnosis and thus earlier therapy initiation.
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Affiliation(s)
- Jan Rudolph
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - Christian Huemmer
- XP Technology and Innovation, Siemens Healthcare GmbH, Forchheim, Germany
| | - Alexander Preuhs
- XP Technology and Innovation, Siemens Healthcare GmbH, Forchheim, Germany
| | - Giulia Buizza
- XP Technology and Innovation, Siemens Healthcare GmbH, Forchheim, Germany
| | - Boj F Hoppe
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center, German Center for Lung Research, Munich, Germany; Department of Radiology, Asklepios Fachklinik München, Gauting, Germany
| | | | - Nicola Fink
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sophia S Goller
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nabeel Mansour
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Fischer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Jörgens
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Rueckel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Bastian O Sabel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Simon ST, Lin M, Trinkley KE, Aleong R, Rafaels N, Crooks KR, Reiter MJ, Gignoux CR, Rosenberg MA. A polygenic risk score for the QT interval is an independent predictor of drug-induced QT prolongation. PLoS One 2024; 19:e0303261. [PMID: 38885227 PMCID: PMC11182491 DOI: 10.1371/journal.pone.0303261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 04/23/2024] [Indexed: 06/20/2024] Open
Abstract
Drug-induced QT prolongation (diLQTS), and subsequent risk of torsade de pointes, is a major concern with use of many medications, including for non-cardiac conditions. The possibility that genetic risk, in the form of polygenic risk scores (PGS), could be integrated into prediction of risk of diLQTS has great potential, although it is unknown how genetic risk is related to clinical risk factors as might be applied in clinical decision-making. In this study, we examined the PGS for QT interval in 2500 subjects exposed to a known QT-prolonging drug on prolongation of the QT interval over 500ms on subsequent ECG using electronic health record data. We found that the normalized QT PGS was higher in cases than controls (0.212±0.954 vs. -0.0270±1.003, P = 0.0002), with an unadjusted odds ratio of 1.34 (95%CI 1.17-1.53, P<0.001) for association with diLQTS. When included with age and clinical predictors of QT prolongation, we found that the PGS for QT interval provided independent risk prediction for diLQTS, in which the interaction for high-risk diagnosis or with certain high-risk medications (amiodarone, sotalol, and dofetilide) was not significant, indicating that genetic risk did not modify the effect of other risk factors on risk of diLQTS. We found that a high-risk cutoff (QT PGS ≥ 2 standard deviations above mean), but not a low-risk cutoff, was associated with risk of diLQTS after adjustment for clinical factors, and provided one method of integration based on the decision-tree framework. In conclusion, we found that PGS for QT interval is an independent predictor of diLQTS, but that in contrast to existing theories about repolarization reserve as a mechanism of increasing risk, the effect is independent of other clinical risk factors. More work is needed for external validation in clinical decision-making, as well as defining the mechanism through which genes that increase QT interval are associated with risk of diLQTS.
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Affiliation(s)
- Steven T. Simon
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Meng Lin
- Colorado Center for Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Katy E. Trinkley
- Department of Clinical Pharmacy, School of Pharmacy, University of Colorado, Aurora, CO, United States of America
| | - Ryan Aleong
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Nicholas Rafaels
- Colorado Center for Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Kristy R. Crooks
- Colorado Center for Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Michael J. Reiter
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Christopher R. Gignoux
- Colorado Center for Personalized Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Michael A. Rosenberg
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States of America
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Russell FM, Harrison NE, Hobson O, Montelauro N, Vetter CJ, Brenner D, Kennedy S, Hunter BR. Diagnostic accuracy of prehospital lung ultrasound for acute decompensated heart failure: A systematic review and Meta-analysis. Am J Emerg Med 2024; 80:91-98. [PMID: 38522242 DOI: 10.1016/j.ajem.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Lung ultrasound (LUS) reduces time to diagnosis and treatment of acute decompensated heart failure (ADHF) in emergency department (ED) patients with undifferentiated dyspnea. We conducted a systematic review to evaluate the diagnostic accuracy and clinical impact of LUS for ADHF in the prehospital setting. METHODS We performed a keyword search of multiple databases from inception through June 1, 2023. Included studies were those enrolling prehospital patients with undifferentiated dyspnea or suspected ADHF, and specifically diagnostic studies comparing prehospital LUS to a gold standard and intervention studies with a non-US comparator group. Title and abstract screening, full text review, risk of bias (ROB) assessments, and data extraction were performed by multiple authors. and adjudicated. The primary outcome was pooled sensitivity, specificity, and diagnostic likelihood ratios (LR) for prehospital LUS. A test-treatment threshold of 0.7 was applied based on prior ADHF literature in the ED. Intervention outcomes included mortality, mechanical ventilation, and time to HF specific treatment. RESULTS Eight diagnostic studies (n = 691) and two intervention studies (n = 70) met inclusion criteria. No diagnostic studies were low-ROB. Both intervention studies were critical-ROB, and not pooled. Pooled sensitivity and specificity of prehospital LUS for ADHF were 86.7% (95%CI:70.8%-94.6%) and 87.5% (78.2%-93.2%), respectively, with similar performance by physician vs. paramedic LUS and number of lung zones evaluated. Pooled LR+ and LR- were 7.27 (95% CI: 3.69-13.10) and 0.17 (95% CI: 0.06-0.34), respectively. Area under the summary receiver operating characteristic curve was 0.922. At the observed 42.4% ADHF prevalence (pre-test probability), positive pre-hospital LUS exceeded the 70% threshold to initiate treatment (post-test probability 84%, 80-88%). CONCLUSIONS LUS had similar diagnostic test characteristics for ADHF diagnosis in the prehospital setting as in the ED. A positive prehospital LUS may be sufficient to initiate early ADHF treatment based on published test-treatment thresholds. More studies are needed to determine the clinical impact of prehospital LUS.
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Affiliation(s)
- Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, IN 46202, United States of America.
| | - Nicholas E Harrison
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, IN 46202, United States of America
| | - Oliver Hobson
- Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Nicholas Montelauro
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Cecelia J Vetter
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America
| | - Daniel Brenner
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, IN 46202, United States of America
| | - Sarah Kennedy
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, IN 46202, United States of America
| | - Benton R Hunter
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, IN 46202, United States of America
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Pare JR, Gjesteby LA, Tonelli M, Leo MM, Muruganandan KM, Choudhary G, Brattain LJ. Transfer Learning-Based B-Line Assessment of Lung Ultrasound for Acute Heart Failure. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:825-832. [PMID: 38423896 DOI: 10.1016/j.ultrasmedbio.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE B-lines assessed by lung ultrasound (LUS) outperform physical exam, chest radiograph, and biomarkers for the associated diagnosis of acute heart failure (AHF) in the emergent setting. The use of LUS is however limited to trained professionals and suffers from interpretation variability. The objective was to utilize transfer learning to create an AI-enabled software that can aid novice users to automate LUS B-line interpretation. METHODS Data from an observational AHF LUS study provided standardized cine clips for AI model development and evaluation. A total of 49,952 LUS frames from 30 patients were hand scored and trained on a convolutional neural network (CNN) to interpret B-lines at the frame level. A random independent evaluation set of 476 LUS clips from 60 unique patients assessed model performance. The AI models scored the clips on both a binary and ordinal 0-4 multiclass assessment. RESULTS A multiclassification AI algorithm had the best performance at the binary level when applied to the independent evaluation set, AUC of 0.967 (95% CI 0.965-0.970) for detecting pathologic conditions. When compared to expert blinded reviewer, the 0-4 multiclassification AI algorithm scale had a reported linear weighted kappa of 0.839 (95% CI 0.804-0.871). CONCLUSIONS The multiclassification AI algorithm is a robust and well performing model at both binary and ordinal multiclass B-line evaluation. This algorithm has the potential to be integrated into clinical workflows to assist users with quantitative and objective B-line assessment for evaluation of AHF.
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Affiliation(s)
- Joseph R Pare
- Alpert Medical School of Brown University, Providence, RI, USA; Lifespan, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA; Boston University, Boston, MA, USA.
| | - Lars A Gjesteby
- Human Health & Performance Systems Group, MIT Lincoln Laboratory, Lexington, MA, USA
| | | | | | | | - Gaurav Choudhary
- Alpert Medical School of Brown University, Providence, RI, USA; Lifespan, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Laura J Brattain
- Human Health & Performance Systems Group, MIT Lincoln Laboratory, Lexington, MA, USA
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Sheehan M, Sokoloff L, Reza N. Acute Heart Failure: From The Emergency Department to the Intensive Care Unit. Cardiol Clin 2024; 42:165-186. [PMID: 38631788 PMCID: PMC11064814 DOI: 10.1016/j.ccl.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Acute heart failure (AHF) is a frequent cause of hospitalization around the world and is associated with high in-hospital and post-discharge morbidity and mortality. This review summarizes data on diagnosis and management of AHF from the emergency department to the intensive care unit. While more evidence is needed to guide risk stratification and care of patients with AHF, hospitalization is a key opportunity to optimize evidence-based medical therapy for heart failure. Close linkage to outpatient care is essential to improve post-hospitalization outcomes.
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Affiliation(s)
- Megan Sheehan
- Division of Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Maloney Building 5th Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Lara Sokoloff
- Division of Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Maloney Building 5th Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Room 11-145, Philadelphia, PA 19104, USA.
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Villén T, Tung Y, Llamas R, Neria F, Carballo C, Vázquez JL, Monge D. Results of the implementation of a double-check protocol with point-of-care ultrasound for acute heart failure in the emergency department. Ultrasound J 2024; 16:25. [PMID: 38632169 PMCID: PMC11024074 DOI: 10.1186/s13089-024-00373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To determine the effectiveness of a double-check protocol using Point-of-Care Ultrasound in the management of patients diagnosed with Acute Heart Failure in an Emergency Department. METHOD Prospective analytical cross-sectional observational study with patients diagnosed with Acute Heart Failure by the outgoing medical team, who undergo multi-organ ultrasound evaluation including cardiac, pulmonary, and inferior vena cava ultrasound. RESULTS 96 patients were included. An alternative diagnosis was found in 33% of them. Among the 77% where AHF diagnosis was confirmed, 73.4% had an underlying cause or condition not previously known (Left Ventricular Ejection Fraction less than 40% or moderate-severe valvulopathy). The introduction of the protocol had a clinically relevant impact on 47% of all included patients. CONCLUSIONS The implementation of a double-check protocol using POCUS, including cardiac, pulmonary, and inferior vena cava assessment in patients diagnosed with Acute Heart Failure, demonstrates a high utility in ensuring accurate diagnosis and proper classification of these patients.
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Affiliation(s)
- Tomás Villén
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Yale Tung
- Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - Rafael Llamas
- Emergency Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Fernando Neria
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - César Carballo
- Emergency Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José Luis Vázquez
- Pediatric Intensive Care Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Diana Monge
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
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Szyszkowska A, Olesiewicz T, Płońska-Korabiewska I, Tarasiuk E, Olesiewicz B, Knapp M, Śledziewski R, Sobkowicz B, Lisowska A. The Importance of Lung Ultrasound and IGFBP7 (Insulin-like Growth Factor Binding Protein 7) Assessment in Diagnosing Patients with Heart Failure. J Clin Med 2024; 13:2220. [PMID: 38673493 PMCID: PMC11051327 DOI: 10.3390/jcm13082220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/30/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: In daily practice, there are problems with adequately diagnosing the cause of dyspnea in patients with heart failure with preserved and mildly reduced ejection fractions (HFpEF and HFmrEF). This study aimed to assess the usefulness of lung ultrasound in diagnosing HFpEF and HFmrEF and determine its correlation with IGFBP7 (insulin-like growth factor binding protein 7), NTproBNP (N-terminal pro-B-type natriuretic peptide), and echocardiographic markers. Methods: The research was conducted on 143 patients hospitalized between 2018 and 2020, admitted due to dyspnea, and diagnosed with HFpEF and HFmrEF. Venous blood was collected from all participants to obtain basic biochemical parameters, NTproBNP, and IGFBP7. Moreover, all participants underwent echocardiography and transthoracic lung ultrasound. Two years after hospitalization a follow-up telephone visit was performed. Results: The number of B-lines in the LUS ≥ 16 was determined with a sensitivity of-73% and specificity of-62%, indicating exacerbation of heart failure symptoms on admission. The number of B-lines ≥ 14 on admission was determined as a cut-off point, indicating an increased risk of death during the 2-year follow-up period. The factors that significantly impacted mortality in the study patient population were age and the difference between the number of B-lines on ultrasound at admission and at hospital discharge. IGFBP7 levels had no significant effect on the duration of hospitalization, risk of rehospitalization, or mortality during follow-up. Conclusions: Lung ultrasonography provides additional diagnostic value in patients with HFpEF or HFmrEF and exacerbation of heart failure symptoms. The number of B-lines ≥ 14 may indicate an increased risk of death.
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Affiliation(s)
- Anna Szyszkowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Tomasz Olesiewicz
- Department of Cardiology, Hospital in Ostrów Mazowiecka, 07-300 Ostrów Mazowiecka, Poland; (T.O.); (B.O.)
| | - Izabela Płońska-Korabiewska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Ewa Tarasiuk
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Barbara Olesiewicz
- Department of Cardiology, Hospital in Ostrów Mazowiecka, 07-300 Ostrów Mazowiecka, Poland; (T.O.); (B.O.)
| | - Małgorzata Knapp
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Rafał Śledziewski
- Department of Radiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
| | - Anna Lisowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (I.P.-K.); (E.T.); (M.K.); (B.S.)
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Miró Ò, Llorens P, Aguiló S, Alquézar-Arbé A, Fernández C, Burillo-Putze G, Marcos NC, Marañón AA, Oms GS, Del Castillo JG. Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study. Rev Clin Esp 2024; 224:204-216. [PMID: 38423386 DOI: 10.1016/j.rceng.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. METHODS All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. RESULTS We included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95% CI: 25.0-28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95% CI: 5.39-1015. and 42.6, 3.74-485, respectively and hypoxemia (2.14, 1.27-3.61; and 1.87, 1.19-2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04-4.83; and 2.48, 1.27-4.86) and age (per 10-year increment; 1.54, 1.04-2.29; and 1.60, 1.13-2.28). The combined post-discharge adverse event was not associated with any characteristic. CONCLUSIONS AHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.
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Affiliation(s)
- Ò Miró
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain.
| | - S Aguiló
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - C Fernández
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - G Burillo-Putze
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain
| | - N C Marcos
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - A A Marañón
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - G S Oms
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - J G Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
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Wu MJ, Chen CH, Tsai SF. Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study. Front Pharmacol 2024; 15:1367790. [PMID: 38510647 PMCID: PMC10953504 DOI: 10.3389/fphar.2024.1367790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Heart failure with reduced ejection fraction (HFrEF) poses significant health risks. Midodrine for maintaining blood pressure in HFrEF, requires further safety investigation. This study explores midodrine's safety in HFrEF through extensive matched analysis. Methods: Patients with HFrEF (LVEF <50%) without malignancy, non-dialysis dependence, or non-orthostatic hypotension, were enrolled between 28 August 2013, and 27 August 2023. Propensity score matching (PSM) created 1:1 matched groups. Outcomes included mortality, stage 4 and 5 chronic kidney disease (CKD), emergency room (ER) visits, intensive care unit (ICU) admissions, hospitalizations, and respiratory failure. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated for each outcome, and Kaplan-Meier survival analysis was performed. Subgroup analyses were conducted based on gender, age (20-<65 vs. ≥65), medication refill frequency, and baseline LVEF. Results: After 1:1 PSM, 5813 cases were included in each group. The midodrine group had higher risks of respiratory failure (HR: 1.16, 95% CI: 1.08-1.25), ICU admissions (HR: 1.14, 95% CI: 1.06-1.23), hospitalizations (HR: 1.21, 95% CI: 1.12-1.31), and mortality (HR: 1.090, 95% CI: 1.01-1.17). Interestingly, midodrine use reduced ER visits (HR: 0.77, 95% CI: 0.71-0.83). Similar patterns of lower ER visit risk and higher risks for ICU admissions, respiratory failure, and overall hospitalizations were observed in most subgroups. Conclusion: In this large-scale study, midodrine use was associated with reduced ER visits but increased risks of respiratory failure, prolonged ICU stays, higher hospitalizations, and elevated mortality in HFrEF patients. Further research is needed to clarify midodrine's role in hemodynamic support and strengthen existing evidence.
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Affiliation(s)
- Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
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Spampinato MD, Luppi F, Cristofaro E, Benedetto M, Cianci A, Bachechi T, Ghirardi C, Perna B, Guarino M, Passaro A, De Giorgio R, Sofia S. Diagnostic accuracy of Point Of Care UltraSound (POCUS) in clinical practice: A retrospective, emergency department based study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:255-264. [PMID: 38059395 DOI: 10.1002/jcu.23619] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
AIMS Point-of-care ultrasound (POCUS) is the acquisition and interpretation of ultrasound imaging at the bedside to solve specific clinical questions based on signs and symptoms of presentation. While several studies evaluated POCUS diagnostic accuracy for a variety of clinical pictures in the emergency department (ED), only a few data are available on POCUS diagnostic accuracy performed by physicians with different POCUS skills. The objective of this research was to evaluate the diagnostic accuracy of POCUS compared to standard diagnostic imaging in the ED. MATERIALS AND METHODS This was a retrospective study conducted in the ED of a third-level university hospital. Patients who underwent cardiac, thoracic, abdominal, or venous lower limb POCUS and a standard imaging examination between June 2021 and January 2022 were included. RESULTS 1047 patients were screened, and 844 patients included. A total of 933 POCUS was included (102, 12.09%, cardiac; 466, 55.21%, thoracic; 336, 39.8%, abdominal; 29, 3.44%, lower limb venous POCUS), accounting for 2029 examinations. POCUS demonstrated 96.6% (95% CI 95.72-97.34) accuracy, 47.73 (95% CI 33.64-67.72) +LR, 0.09 (95% CI 0.06-0.12) -LR. +LR was greater than 10 for all investigations but for hydronephrosis (5.8), and -LR never exceeded 0.4. CONCLUSIONS POCUS exhibited high diagnostic accuracy for virtually all conditions when performed by emergency department physicians.
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Affiliation(s)
- Michele Domenico Spampinato
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Francesco Luppi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Enrico Cristofaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Marcello Benedetto
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Antonella Cianci
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Tommaso Bachechi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Caterina Ghirardi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Benedetta Perna
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Angelina Passaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Soccorsa Sofia
- Emergency Department, Maggiore Hospital, AUSL di Bologna, Bologna, Italy
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Abstract
Acute heart failure (AHF) is a clinical complex disease and a worldwide issue due to its inconsistent diagnosis and poor prognosis. The cornerstone of pathophysiology of AHF is systemic venous congestion, which is led by the underlying structural and functional cardiac condition. Systemic venous congestion is a major target for AHF management because it causes symptoms and organs dysfunction, and is associated with poor prognosis. The mainstay of decongestive therapy is diuresis with intravenous loop diuretics combined with other diuretics including thiazides when necessary, and non-invasive ventilation. The presence of unresolved congestion at discharge can lead heart failure related rehospitalization, and careful follow-up is required especially during "vulnerable phase", several months after discharge. The updated recommendation for management of AHF has been provided by latest guidelines from European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America. Several large studies have currently demonstrated the benefits of guideline-directed oral medical therapies, and trials are ongoing on medication such as selective sodium-glucose transport proteins 2 inhibitors and protocols for congestive therapy. This review aimed to summarize the latest insights in AHF, based primarily on the most recent guidelines and large randomized controlled trials.
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Affiliation(s)
- Ayu Asakage
- Université de Paris Cité, Paris, France; INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France.
| | - Alexandre Mebazaa
- Université de Paris Cité, Paris, France; INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France; Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis-Lariboisière, AP-HP, Paris, France; FHU PROMICE
| | - Benjamin Deniau
- Université de Paris Cité, Paris, France; INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France; Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis-Lariboisière, AP-HP, Paris, France; FHU PROMICE; INI-CRCT
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Odrobina I. Clinical Predictive Modeling of Heart Failure: Domain Description, Models' Characteristics and Literature Review. Diagnostics (Basel) 2024; 14:443. [PMID: 38396482 PMCID: PMC10888082 DOI: 10.3390/diagnostics14040443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
This study attempts to identify and briefly describe the current directions in applied and theoretical clinical prediction research. Context-rich chronic heart failure syndrome (CHFS) telemedicine provides the medical foundation for this effort. In the chronic stage of heart failure, there are sudden exacerbations of syndromes with subsequent hospitalizations, which are called acute decompensation of heart failure (ADHF). These decompensations are the subject of diagnostic and prognostic predictions. The primary purpose of ADHF predictions is to clarify the current and future health status of patients and subsequently optimize therapeutic responses. We proposed a simplified discrete-state disease model as an attempt at a typical summarization of a medical subject before starting predictive modeling. The study tries also to structure the essential common characteristics of quantitative models in order to understand the issue in an application context. The last part provides an overview of prediction works in the field of CHFS. These three parts provide the reader with a comprehensive view of quantitative clinical predictive modeling in heart failure telemedicine with an emphasis on several key general aspects. The target community is medical researchers seeking to align their clinical studies with prognostic or diagnostic predictive modeling, as well as other predictive researchers. The study was written by a non-medical expert.
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Affiliation(s)
- Igor Odrobina
- Mathematical Institute, Slovak Academy of Science, Štefánikova 49, SK-841 73 Bratislava, Slovakia
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46
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Harrison NE, Ehrman R, Collins S, Desai AA, Duggan NM, Ferre R, Gargani L, Goldsmith A, Kapur T, Lane K, Levy P, Li X, Noble VE, Russell FM, Pang P. The prognostic value of improving congestion on lung ultrasound during treatment for acute heart failure differs based on patient characteristics at admission. J Cardiol 2024; 83:121-129. [PMID: 37579872 PMCID: PMC10859542 DOI: 10.1016/j.jjcc.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Lung ultrasound congestion scoring (LUS-CS) is a congestion severity biomarker. The BLUSHED-AHF trial demonstrated feasibility for LUS-CS-guided therapy in acute heart failure (AHF). We investigated two questions: 1) does change (∆) in LUS-CS from emergency department (ED) to hospital-discharge predict patient outcomes, and 2) is the relationship between in-hospital decongestion and adverse events moderated by baseline risk-factors at admission? METHODS We performed a secondary analysis of 933 observations/128 patients from 5 hospitals in the BLUSHED-AHF trial receiving daily LUS. ∆LUS-CS from ED arrival to inpatient discharge (scale -160 to +160, where negative = improving congestion) was compared to a primary outcome of 30-day death/AHF-rehospitalization. Cox regression was used to adjust for mortality risk at admission [Get-With-The-Guidelines HF risk score (GWTG-RS)] and the discharge LUS-CS. An interaction between ∆LUS-CS and GWTG-RS was included, under the hypothesis that the association between decongestion intensity (by ∆LUS-CS) and adverse outcomes would be stronger in admitted patients with low-mortality risk but high baseline congestion. RESULTS Median age was 65 years, GWTG-RS 36, left ventricular ejection fraction 36 %, and ∆LUS-CS -20. In the multivariable analysis ∆LUS-CS was associated with event-free survival (HR = 0.61; 95 % CI: 0.38-0.97), while discharge LUS-CS (HR = 1.00; 95%CI: 0.54-1.84) did not add incremental prognostic value to ∆LUS-CS alone. As GWTG-RS rose, benefits of LUS-CS reduction attenuated (interaction p < 0.05). ∆LUS-CS and event-free survival were most strongly correlated in patients without tachycardia, tachypnea, hypotension, hyponatremia, uremia, advanced age, or history of myocardial infarction at ED/baseline, and those with low daily loop diuretic requirements. CONCLUSIONS Reduction in ∆LUS-CS during AHF treatment was most associated with improved readmission-free survival in heavily congested patients with otherwise reassuring features at admission. ∆LUS-CS may be most useful as a measure to ensure adequate decongestion prior to discharge, to prevent early readmission, rather than modify survival.
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Affiliation(s)
- Nicholas E Harrison
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, USA.
| | - Robert Ehrman
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI, USA
| | - Sean Collins
- Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN, USA
| | - Ankit A Desai
- Indiana University School of Medicine, Department of Medicine, Division of Cardiology, Indianapolis, IN, USA
| | - Nicole M Duggan
- Brigham and Womens Hospital, Department of Emergency Medicine, Boston, MA, USA
| | - Rob Ferre
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, USA
| | - Luna Gargani
- University of Pisa, Cardiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa, Italy
| | - Andrew Goldsmith
- Brigham and Womens Hospital, Department of Emergency Medicine, Boston, MA, USA
| | - Tina Kapur
- Brigham and Womens Hospital, Department of Radiology, Boston, MA, USA
| | - Katie Lane
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Phillip Levy
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI, USA
| | - Xiaochun Li
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Vicki E Noble
- Case Western Reserve University, Department of Emergency Medicine, Cleveland, OH, USA
| | - Frances M Russell
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, USA
| | - Peter Pang
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, USA
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Phipps G, Sowden N, Mikkelsen K, Fincher G, Ranasinghe I, Atkins L, Jordan F, Chan W. Contemporary management of acute heart failure in the emergency department and the potential impact of early diuretic therapy on outcomes. Emerg Med Australas 2024; 36:71-77. [PMID: 37666655 DOI: 10.1111/1742-6723.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Acute heart failure (AHF) is one of the most common conditions presenting to the ED and patients often require hospitalisation. Emerging evidence suggests early diagnosis and administration of diuretics are associated with improved patient outcomes. Currently, there is limited literature on the management of AHF in the Australian ED context. METHODS A retrospective review of consecutive AHF presentations to the ED in a metropolitan hospital. Patient demographics, clinical status and management were assessed including timeliness of diuretics administration and association with outcomes including ED length of stay (LOS) and inpatient mortality using linear regression. RESULTS One hundred and ninety-one presentations (median age 81 years, 50.8% male) were identified. Common cardiovascular comorbidities were prevalent. Fifty-four patients (28.3%) had ≥1 clinical high-risk feature at presentation. The median time from presentation to furosemide administration was 187 min (interquartile range 97-279 min); only 35 patients received diuretics within 60 min of presentation. Early diuretics was associated with shorter ED LOS (246 min vs 275 min, P = 0.03) and a lower but non-significant inpatient mortality (4.9% vs 6.3%, P = 0.21) and a non-significant increased rate of discharge home from ED (8.6% vs 4.7%, P = 0.15). The likelihood of discharge home was significantly more pronounced in patients receiving early diuretics without clinical high-risk features (16.7% vs 4.3%, P = 0.028). CONCLUSION Despite symptoms and signs being well recognised at presentation, time to diuretics was relatively long. Early diuretics administration was associated with improved patient outcomes, particularly in clinically more stable patients. Due to the limitations of the study design, results should be interpreted with caution and warrant further research to identify factors that delay timely administration of diuretics.
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Affiliation(s)
- Genevieve Phipps
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas Sowden
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Kellie Mikkelsen
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Gavin Fincher
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Isuru Ranasinghe
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Lauren Atkins
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Faye Jordan
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Wandy Chan
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Magaña Serrano JA, Cigarroa López JA, Chávez Mendoza A, Ivey-Miranda JB, Mendoza Zavala GH, Olmos Domínguez L, Chávez Leal SA, Pombo Bartelt JE, Herrera-Garza EH, Mercado Leal G, Parra Michel R, Aguilera Mora LF, Nuriulu Escobar PL. Vulnerable period in heart failure: a window of opportunity for the optimization of treatment - a statement by Mexican experts. Drugs Context 2024; 13:2023-8-1. [PMID: 38264402 PMCID: PMC10803129 DOI: 10.7573/dic.2023-8-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
Acute heart failure (HF) is associated with poor prognosis. After the acute event, there is a vulnerable period during which the patient has a marked risk of readmission or death. Therefore, early optimization of treatment is mandatory during the vulnerable period. The objective of this article is to provide recommendations to address the management of patients with HF during the vulnerable period from a practical point of view. A group of Mexican experts met to prepare a consensus document. The vulnerable period, with a duration of up to 6 months after the acute event - either hospitalization, visit to the emergency department or the outpatient clinic/day hospital - represents a real window of opportunity to improve outcomes for these patients. To best individualize the recommendations, the management strategies were divided into three periods (early, intermediate and late vulnerable period), including not only therapeutic options but also evaluation and education. Importantly, the recommendations are addressed to the entire cardiology team, including physicians and nurses, but also other specialists implicated in the management of these patients. In conclusion, this document represents an opportunity to improve the management of this population at high risk, with the aim of reducing the burden of HF.
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Affiliation(s)
- José Antonio Magaña Serrano
- División de Insuficiencia Cardiaca y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Angel Cigarroa López
- Clínica de Insuficiencia Cardiaca Avanzada y Trasplantes de la UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS (Instituto Mexicano del Seguro Social), Ciudad de México, México
| | - Adolfo Chávez Mendoza
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Juan Betuel Ivey-Miranda
- Clínica de Insuficiencia Cardiaca Avanzada y Trasplantes de la UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS (Instituto Mexicano del Seguro Social), Ciudad de México, México
| | - Genaro Hiram Mendoza Zavala
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Luis Olmos Domínguez
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | | | | | - Eduardo Heberto Herrera-Garza
- Programa de Trasplante Cardiaco y Clínica de Insuficiencia Cardíaca, Hospital Christus Muguerza Alta Especialidad, Monterrey, México
| | - Gerardo Mercado Leal
- División de Cardiocirugía, Clínica de Insuficiencia Cardiaca, Trasplante Cardiaco y Hospital de Día, CMN 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Rodolfo Parra Michel
- Unidad de Coronaria y Clínica de Insuficiencia Cardíaca Avanzada e Hipertensión Arterial Pulmonar. Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Luisa Fernanda Aguilera Mora
- Clínica de Insuficiencia Cardiaca, Instituto Cardiovascular de Mínima Invasión, Centro Médico Puerta de Hierro, Zapopan, México
| | - Patricia Lenny Nuriulu Escobar
- Unidad de Insuficiencia Cardiaca y Cardio-Oncología del Instituto Cardiovascular de Hidalgo, Pachuca de Soto Hidalgo, Fellow SIAC, Pachuca de Soto, México
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Schmitz T, Wein B, Raake P, Heier M, Peters A, Linseisen J, Meisinger C. Do patients with diabetes with new onset acute myocardial infarction present with different symptoms than non-diabetic patients? Front Cardiovasc Med 2024; 11:1324451. [PMID: 38287984 PMCID: PMC10822885 DOI: 10.3389/fcvm.2024.1324451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/03/2024] [Indexed: 01/31/2024] Open
Abstract
Background The objective of this study was to investigate the differences in presenting symptoms between patients with and without diabetes being diagnosed with an acute myocardial infarction (AMI). Methods A total of 5,900 patients with a first-time AMI were included into the analysis. All patients aged between 25 and 84 years were recorded by the population-based Myocardial Infarction Registry in Augsburg, Germany, between 2010 and 2017. The presence (yes/no) of 12 AMI typical symptoms during the acute event was assessed within the scope of a face-to-face interview. Multivariable adjusted logistic regression models were calculated to analyze the associations between presenting symptoms and diabetes mellitus in AMI patients. Results Patients with diabetes had significantly less frequent typical pain symptoms, including typical chest pain. Also, other symptoms like sweating, vomiting/nausea, dizziness/vertigo and fear of death/feeling of annihilation occurred significantly more likely in non-diabetic patients. The only exception was the symptom of shortness of breath, which was found significantly more often in patients with diabetes. In multivariable-adjusted regression models, however, the observed effects were attenuated. In patients younger than 55 years, the associations between diabetes and various symptoms were mainly missing. Conclusions Type 2 diabetes mellitus is a risk factor not only for the development of AMI, but is also associated with an adverse outcome after AMI. Atypical clinical presentation additionally complicates the diagnostic process. It is therefore essential for physicians to be aware of the more often atypical symptoms that diabetic AMI patients report.
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Affiliation(s)
- Timo Schmitz
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Bastian Wein
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Philip Raake
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Margit Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology, Neuherberg, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD) Neuherberg, Neuherberg, Germany
| | - Jakob Linseisen
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
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50
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Kameda T, Ishii H, Oya S, Katabami K, Kodama T, Sera M, Takei H, Taniguchi H, Nakao S, Funakoshi H, Yamaga S, Senoo S, Kimura A. Guidance for clinical practice using emergency and point-of-care ultrasonography. Acute Med Surg 2024; 11:e974. [PMID: 38933992 PMCID: PMC11201855 DOI: 10.1002/ams2.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Owing to the miniaturization of diagnostic ultrasound scanners and their spread of their bedside use, ultrasonography has been actively utilized in emergency situations. Ultrasonography performed by medical personnel with focused approaches at the bedside for clinical decision-making and improving the quality of invasive procedures is now called point-of-care ultrasonography (POCUS). The concept of POCUS has spread worldwide; however, in Japan, formal clinical guidance concerning POCUS is lacking, except for the application of focused assessment with sonography for trauma (FAST) and ultrasound-guided central venous cannulation. The Committee for the Promotion of POCUS in the Japanese Association for Acute Medicine (JAAM) has often discussed improving the quality of acute care using POCUS, and the "Clinical Guidance for Emergency and Point-of-Care Ultrasonography" was finally established with the endorsement of JAAM. The background, targets for acute care physicians, rationale based on published articles, and integrated application were mentioned in this guidance. The core points include the fundamental principles of ultrasound, airway, chest, cardiac, abdominal, and deep venous ultrasound, ultrasound-guided procedures, and the usage of ultrasound based on symptoms. Additional points, which are currently being considered as potential core points in the future, have also been widely mentioned. This guidance describes the overview and future direction of ultrasonography for acute care physicians and can be utilized for emergency ultrasound education. We hope this guidance will contribute to the effective use of ultrasonography in acute care settings in Japan.
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Affiliation(s)
- Toru Kameda
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Clinical Laboratory MedicineJichi Medical UniversityShimotsukeJapan
| | - Hiromoto Ishii
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Seiro Oya
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineShizuoka Medical CenterShizuokaJapan
| | - Kenichi Katabami
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care CenterHokkaido University HospitalSapporoJapan
| | - Takamitsu Kodama
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and General Internal MedicineTajimi City HospitalTajimiJapan
| | - Makoto Sera
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineFukui Prefectural HospitalFukuiJapan
| | - Hirokazu Takei
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineHyogo Prefectural Kobe Children's HospitalKobeJapan
| | - Hayato Taniguchi
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Shunichiro Nakao
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hiraku Funakoshi
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu Ichikawa Medical CenterUrayasuJapan
| | - Satoshi Yamaga
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Radiation Disaster Medicine, Research Institute for Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
| | - Satomi Senoo
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineSaiseikai Yokohamashi Tobu HospitalYokohamaJapan
| | - Akio Kimura
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical CareCenter Hospital of the National Center for Global Health and MedicineTokyoJapan
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