Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting

Between March 2011 and March 2012, 90 consecutive patients (45 women, 78.1？±？9.9？years) admitted to the emergency room of our hospital for acute dyspnea were enrolled. Within 30？minutes of admission, all patients underwent conventional physical examination, rapid ultrasound (lung-cardiac-inferior vena cava [LCI] integrated ultrasound) examination with a hand-held device, routine laboratory tests, measurement of brain natriuretic peptide, and chest X-ray in the emergency room.The final diagnosis was acute dyspnea due to AHFS in 53 patients, acute dyspnea due to pulmonary disease despite a history of heart failure in 18 patients, and acute dyspnea due to pulmonary disease in 19 patients. Lung ultrasound alone showed a sensitivity, specificity, negative predictive value, and positive predictive value of 96.2, 54.0, 90.9, and 75.0%, respectively, for differentiating AHFS from pulmonary disease. On the other hand, LCI integrated ultrasound had a sensitivity, specificity, negative predictive value, and positive predictive value of 94.3, 91.9, 91.9, and 94.3%, respectively.Our study demonstrated that rapid evaluation by LCI integrated ultrasound is extremely accurate for differentiating acute dyspnea due to AHFS from that caused by primary pulmonary disease in the emergency setting.Acute dyspnea is one of the main reasons for admission to the emergency department (ED) [1]. Physicians working in the ED often need to make a rapid diagnosis and devise a treatment plan on the basis of limited clinical information [2,3]. In paticular, acute heart failue syndromes (AHFS) are challenging, since the clinical, radiographic, and laboratory parameters have variable diagnostic value because AHFS are a heterogeneous set of clinical syndromes [4]. Traditional diagnostic criteria for heart failure are based on the history, physical examination, and chest radiograph findings [5-8]. However, these criteria are often not very useful for ED patients because of only having intermediate accura