Pivetta
Trial question
What is the role of lung ultrasound integrated with clinical assessment in patients with acute decompensated HF in the emergency department?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
47.0% female
53.0% male
N = 518
518 patients (241 female, 277 male).
Inclusion criteria: adult patients who presented to the emergency department with acute dyspnea.
Key exclusion criteria: mechanical ventilation with positive pressure, either invasively or non‐invasively, at the time of first evaluation, or presentation with acute dyspnea in the context of trauma.
Interventions
N=258 LUS (lung ultrasound with clinical assessment).
N=260 CXR/NT-proBNP (chest radiography and level of N-terminal pro-BNP with clinical evaluation).
Primary outcome
Diagnostic accuracy, area under receiver operating characteristic curve
94.5%
87.2%
94.5 %
70.9 %
47.3 %
23.6 %
0.0 %
LUS
CXR/NT-proBNP
Significant
increase ▲
NNT = 13
Significant increase in diagnostic accuracy, area under the receiver operating characteristic curve (94.5% vs. 87.2%; AD 7.3%, 95% CI 1.74 to 12.86).
Secondary outcomes
Significant decrease in median time needed to formulate the diagnostic hypothesis (5 min vs. 104.5 min; AD -99.5 min, 95% CI -175.23 to -23.77).
Safety outcomes
No significant difference in death in the hospital.
Conclusion
In adult patients who presented to the emergency department with acute dyspnea, LUS was superior to CXR/NT-proBNP with respect to diagnostic accuracy, area under the receiver operating characteristic curve.
Reference
Emanuele Pivetta, Alberto Goffi, Peiman Nazerian et al. Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial. Eur J Heart Fail. 2019 Jun;21(6):754-766.
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