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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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28. Risk Factors and Prevention
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31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Abstract
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CLEAR FILTERS
CHEST ULTRASOUND VS. NATRIURETIC PEPTIDES FOR THE DIFFERENTIAL DIAGNOSIS OF ACUTE CARDIAC DYSPNOEA
Session:
Painel 2 - Insuficiência Cardíaca 10
Speaker:
TELMA PAREDES SILVA DUARTE ELIAS
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.7 Acute Heart Failure - Other
Session Type:
Posters
FP Number:
---
Authors:
Telma Elias; Luís Graça Santos; Rui Encarnado Assis; Inês Coelho dos Santos; Andre Neto Real; L. França; Ana Araujo; T. Pereira; L. Pessoa; N. Catorze
Abstract
<p>Introduction: N-terminal pro B-type natriuretic peptide (NT-proBNP) is a useful tool for heart failure (HF) diagnosis and a well-established and independent marker of worse prognosis. In the context of critical illness it seems less useful from a diagnostic perspective, while chest ultrasonography (CUS) allows rapid determination of cardiac function, intravascular volume status, and pulmonary oedema.<br /> Aim: To compare the accuracy of CUS and NT-proBNP for predicting HF among patients (pts) with acute dyspnoea.<br /> Methods: We prospectively evaluated 26 pts admitted to our intensive care unit (ICU) due to acute dyspnoea, between January and March 2018. In the first 12 hours, CUS was performed and NT-proBNP levels assessed in each pt. Ultrasound protocol included lung (B-lines) and cardiac evaluation (left ventricular ejection fraction (LVEF), diastolic filling (E/e´) and inferior vena cava collapsibility index (IVCi)). A positive exam was defined according to the presence of ≥3 bilateral B-lines plus 2 of 3 of the following: LVEF <50%; E/e´>14; IVCi <25%. Two independent physicians, blinded to CUS and NT-proBNP findings, reviewed all the medical records to establish the aetiologic diagnosis of dyspnoea. Patients who survived hospital admission were followed for 180 days.<br /> Results: Overall, mean age was 72±15 years and 12 (52%) were female. Cardiogenic dyspnoea was diagnosed in 14 pts (58%) and 12 were clinically diagnosed with non-cardiac dyspnoea. Baseline mortality risk scores did not differ between groups: APACHE II 23±7 vs 24±9, p=0.77; SAPS II 47±13 vs 47±20, p=0.98. Moreover, in-hospital and 180-day mortality rates did not differ according to the aetiology of the acute dyspnoea (29 vs 18%, p=0.66 and 36 vs 18%, p=0.41 respectively). The results from CUS evaluation and NT-proBNP levels among each aetiologic group is depicted in the table. NT-proBNP did not correlate with a positive CUS (r=0.26, p=0.21). Receiver operating characteristic analysis showed an area under the curve of 0.82 (95% confidence interval (CI): 0.65-0.99) for positive CUS and of 0.69 (95%CI: 0.44-0.94) for NT-proBNP in predicting cardiac origin of dyspnoea.<br /> Conclusions: In this cohort of pts admitted to an ICU due to acute dyspnoea, mean NT-proBNP did not differ between cardiac and non-cardiac aetiology. The discrimination power of CUS, a combination of lung and cardiac parameters, in predicting cardiac origin of dyspnoea was high and it was also superior to the one of NT-proBNP.</p>
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