Cardiac And Pulmonary Ultrasound(CPUS) Protocol In Diagnosis Of Acute Heart Failure In The ED:S Meta Analysis

Background:Dyspnea is a common symptom of the Emergency Department(ED).Pneumonia,pulmonary embolism,chronic obstructive pulmonary disease,lung tumors and acute heart failure can cause dyspnea.No obvious differences among them,acute heart failure(AHF)is the most common cause of dyspnea and has a higher mortality rate.Therefore,in a critical state,quickly identifying the cause of dyspnea and giving effective treatment in a timely manner has become the primary task of the emergency department,and it has also brought great challenges to the emergency physician.At present,the main methods for diagnosing and distinguishing dyspnea in the emergency department rely on medical history,physical examination,CXR,CT,and laboratory tests.Physical examination is less accurate in determining heart failure.CT and chest X-rays can detect heart failure Pulmonary edema,but it is difficult to detect occult pulmonary congestion,and it is inconvenient to carry.It requires high patient position.BNP and other laboratory results are delayed.These tests often take a lot of time.However,there are still some patients who cannot be clearly diagnosed,resulting in delayed disease and increased costs and mortality.With the development of ultrasound technology and research by clinicians,pulmonary ultrasound as an emerging tool can quickly and accurately detect pulmonary congestion in acute heart failure.Researchers have found that the agreement formed by the parameters of pulmonary ultrasound and cardiac ultrasound is reliable for acute heart failure Diagnostic value,and is widely used in emergency departments to quickly distinguish the cause of dyspnea.Purpose:In this paper,we use the data of cardiopulmonary ultrasound(CPUS,cardiac and pulmonary ultrasound)to diagnose AHF for meta-analysis to evaluate its diagnostic performance,and find a more reliable and fast imaging method for clinical diagnosis of AHF in the emergency.Methods:Using Lung Ultrasound,Pulmonary,acute heart failure,LUCUS,echocardiography,etc.as the search terms,the combination of subject words and free words was used to search the relevant literatures included in the pubmed,embed,web of science,and cochrane library databases for the past 10 years.According to the established standards,strict screening was included in the same group of studies for the differential diagnosis of AHF in the cardiopulmonary ultrasound program.The selected studies were evaluated for quality using RevMan5.3 software based on the QUADAS tool as the standard,and the basic information and relevant data of the included studies were extracted.If there is no direct data in the text,it can be obtained through calculation.Heterogeneity test was performed using STATA15.1 software,combined sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and diagnostic odds ratio were calculated,and Deek funnel chart was used to detect publication bias.Two-variable mixed-effect model diagram,calculate the I2 value,and evaluate the size of heterogeneity.If the heterogeneity is greater than 50%,the source of heterogeneity needs to be analyzed,and if necessary,subgroup analysis and sensitivity analysis.Result:In this analysis,18 articles were included.The sensitivity and specificity of the cardiopulmonary ultrasound protocol in the diagnosis of acute heart failure combined in the emergency department were 0.92,0.96,and 95% CI were(0.81,0.97),(0.93,0.98).The combined positive likelihood ratio(95% CI 12.8,14.9)and negative likelihood ratio(95% CI 0.03,0.21)were 23.2 and 0.08,respectively,and the combined diagnostic odds ratio was 278,(95% CI 90,859),the area under the SROC curve(AUC)is 0.98.For lung-cardiac-inferior vena cava(LCI)integrated ultrasound diagnostic mode,its sensitivity and specificity for the diagnosis of AHF were 0.954,0.95,and 95% CI were(0.91,0.97),(0.89,0.97).Conclusion:Cardiopulmonary ultrasound has high accuracy in the diagnosis of AHF,especially the cardiopulmonary inferior vena cava combined ultrasound diagnostic mode,and it is fast.It can solve the problem of difficult to quickly identify the cause of dyspnea in the emergency state in emergency,and implement effective treatment for early It provides an opportunity to avoid the occurrence of bad prognosis and has great clinical value.