The Diagnosis Value Of Lung Ultrasound On Bedside Combined With Echocardiogram In Heart Failure

Background and ObjectivesHeart failure is the final destination of the majority of cardiovascular disease,is also a leading cause of death.The diagnosis of left heart failure of pulmonary edema depended on X-ray chest auscultation and Auscultation in long term time.But the sensitivity of inspection in pulmonary edema useing Chest X-ray is not enough.Ultrasonic inspection is an important clinical imaging examination method, which has been considered the restricted area of the diagnosis of pulmonary diseases for a long time.In recent years, with the development of medical research, it is found that ultrasonography can be used in the diagnosis of lung disease more and more widely,because of the high sensitivity and specificity.Even considered it could replaced of the chest X-ray or CT examination in useing of the diagnosis of lung disease in emergency medicine.Echocardiogram on bedside is more and more used in the emergency room, department of internal medicine, ICU and department of anesthesia in patients with heart failure.Echocardiogram on bedside can get lung ultrasound information quickly, it may provide the information of the diagnosis of the heart failure pulmonary with edema.In this study, we analyzed the relationship between the number of B line and the severity of pulmonary edema in heart failure by gathering the number of B lines and multinomial parameters of the heart useing the examination of the echocardiogram on bedside and lung ultrasound.So as to study the diagnosis value in heart failure.Methods:Selected 59 cases who were suspected heart failure in the first affiliated hospital of Soochow University from Mar in 2014 to September in 2014, including 17 cases in NYHA grade Ⅱ group, 18 cases in grade Ⅲ group, 24 casesin in grade Ⅳ group.The clinical data of patients that enrolled in our research were recorded, the number of B lines were detected by lung ultrasound.Chest X-ray radiography on bedsid were examed and the concentration of NT-pro BNP in plasma were detected.(1)Compared the sensitivity and specificity of the diagnosis of pulmonary edema between chest X-ray and lung ultrasound in patients with heart failure.(2)Compared the multinomial parameters of echocardiogram in patients with NYHA cardiac function between Ⅱ-Ⅳ groups.(3)Compared the level of NT-pro BNP in patients with NYHA cardiac function between Ⅱ-Ⅳ groups.(4)Compared the numbers of B line of patients with NYHA cardiac function between Ⅱ-Ⅳ groups.(5)Analysed the correlation between the numbers of B line and the level of NT-pro BNP in plasma.(6)Drawed the ROC curves which diagnosed the numbers of B line and the level of NT-pro BNP in patients with heart failure aboved the level of NYHAⅡ grade.Result:(1)The sensitivity and the specificity of the diagnosis of pulmonary edema with heart failure in lung ultrasound on bedsidein is similar to the chest X-ray.(2) Left ventricular end diastolic dimension,Left ventricular end systolic dimension,Left ventricular end diastolic volume,Left ventricular end systolic volume and the level of LVEF、EDT in grade Ⅲ and Ⅳ groups were higher than grade Ⅱ group significantly(p<0.01).Left atria diameter in grade Ⅳ group were longer than grade Ⅱ group significantly(p<0.05).(3)The number of B lines and the concentration of NT-pro BNP in plasma in grade Ⅳ group were higher than grade Ⅱ and Ⅲ groups significantly(p<0.01).The number of B lines and the concentration of NT-pro BNP in plasma in grade Ⅳ group were higher than grade Ⅲ group significantly(p<0.05).(4)Correlation analysis showed that the number of B lines and the concentration of NT-pro BNP in plasma had a positively correlation(r=0.65,p<0.01).(5)The area of ROC curve by B line was 0.702 in the of diagnosis of heart failure aboved NYHA grade Ⅱ(95%IC:0.562-0.841,p=0.015).The area of ROC curve by the concentration of NT-pro BNP was 0.685 in the of diagnosis of heart failure aboved NYHA grade Ⅱ(95%IC:0.542-0.829,p=0.008).Conclution:(1) Lung ultrasound on bedside is a new method for assessing the severity of pulmonary edema in heart failure, which has the advantages of simple process, reliable conclusion and rapid evaluate.(2) Lung ultrasound on bedside combined with echocardiogram and the concentration of NT-pro BNP in plasma could enhanced the diagnostic value for heart failure.Lung ultrasound may be predicted the progress and prognosis of heart failure.