Ultrassonografia pulmonar na avaliação de dispneia aguda cardiogênica em pacientes hospitalizados

Abstract

Background: Dyspnea is one of the main symptoms of decompensated heart failure; however, its differential diagnosis is a challenge in everyday clinical practice. Lung ultrasound (LU) is a new diagnostic tool of high reproducibility, fast execution and low cost, which can provide important information from acutely ill patients and has shown useful in demonstrating pulmonary interstitial edema (PIE). Objectives: Evaluate the value of LU on identification of PIE in patients with acute cardiogenic dyspnea. Methods: This is a prospective, longitudinal cohort of 109 patients admitted to a cardiology reference hospital with acute dyspnea (60 patients with HF using the Framingham Risk Score (FRS). All were submitted to chest radiography (CR) and UP by a qualified cardiologist. Additional data were obtained by questionnaire and electronic medical record. Results: Of 109 cases, 60 (55%) had CI. These were elder (average age 76±16.7, p=0.01), men (60%, p=0.004), hypertensive (83%, p=0.01), diabetic (50.8%, p=0.03), with chronic renal insufficiency (CRI) (32.2%, p=0.03) and with higher adapted Killip classification (p=0.00) and functional class (p=0.003). Presented more pulmonary interstitial edema (PIE) on LU (p=0,00), CI to CR criteria (p=0.009). There was modest kappa agreement (k) between LU with FRS (k=0.25) and CR (k=0.22) for CI and moderate between LU (k=0,48) and CR and interobserver CR (kappa=0,44). LU sensibility for IEP in patients with CI was 90.91%, 65% specificity, 85.1% positive predictive value and 76.5% negative. Conclusions: LU proved to be a useful tool in the identification of acute cardiogenic dyspnea, with similar accuracy to that reported in literature.