目的:虽然计算机断层扫描(CT)在急性诊断方面被广泛认为优于胸部X光片,其诊断急性心力衰竭(AHF)的疗效尚待探索.这项前瞻性研究包括连续的呼吸困难患者,同时接受低剂量胸部CT(LDCT)和胸部X光片。这里,我们的目的是确定LDCT是否优于胸部X线片,以确认可疑AHF的呼吸困难患者的肺充血。
结果:观察性,前瞻性研究,包括急诊科的呼吸困难患者。所有患者同时接受临床检查,实验室测试,超声心动图,胸部X光片,LDCT。比较两种放射学方法的主要疗效指标是条件比值比(cOR)。主要结果为AHF,由全面的专家共识确定。次要结果,echo-bnpAHF,是基于超声心动图心功能不全的客观AHF诊断,心脏充盈压升高,环状利尿剂给药,和NT-脑钠肽前体>300μg/mL。在228名呼吸困难患者中,64名患者(28%)被裁定为AHF,79例患者(35%)有回声-bnpAHF。AHF患者年龄较大(78岁vs.73年),左心室射血分数较低(36%vs.55%),左心室充盈压升高较高(98%vs.18%),并且具有较高的NT-前体脑钠肽水平(3628pg/mL与470pg/mL)。使用LDCT诊断裁定的AHF和回声bnpAHF的几率高达四倍(cOR:3.89[2.15,7.06]和cOR:2.52[1.45,4.38],分别)。对于每个肺充血的放射学征象,LDCT提供了优于或相当于胸部X光片的结果,使用LDCT,评分者之间的一致性更高(kappa0.88[95%CI:0.81,0.95]与0.73[95%CI:0.63,0.82])。作为一线成像模式,LDCT将在12.5例患者中发现另外一个裁定的AHF,并在20例患者中防止一个假阳性。对于echo-bnpAHF证明了类似的结果。
结论:在急诊科连续收治的呼吸困难患者中,LDCT在检测肺充血方面明显优于胸片。
OBJECTIVE: While computed tomography (CT) is widely acknowledged as superior to chest radiographs for acute diagnostics, its efficacy in diagnosing acute heart failure (AHF) remains unexplored. This prospective study included consecutive patients with dyspnoea undergoing simultaneous low-dose chest CT (LDCT) and chest radiographs. Here, we aimed to determine if LDCT is superior to chest radiographs to confirm pulmonary congestion in dyspnoeic patients with suspected AHF.
RESULTS: An observational, prospective study, including dyspnoeic patients from the emergency department. All patients underwent concurrent clinical examination, laboratory tests, echocardiogram, chest radiographs, and LDCT. The primary efficacy measure to compare the two radiological methods was conditional odds ratio (cOR). The primary outcome was adjudicated AHF, ascertained by comprehensive expert consensus. The secondary outcome, echo-bnp AHF, was an objective AHF diagnosis based on echocardiographic cardiac dysfunction, elevated cardiac filling pressure, loop diuretic administration, and NT-pro brain natriuretic peptide > 300 pg/mL. Of 228 dyspnoeic patients, 64 patients (28%) had adjudicated AHF, and 79 patients (35%) had echo-bnp AHF. Patients with AHF were older (78 years vs. 73 years), had lower left ventricular ejection fraction (36% vs. 55%), had higher elevated left ventricular filling pressures (98% vs. 18%), and had higher NT-pro brain natriuretic peptide levels (3628 pg/mL vs. 470 pg/mL). The odds to diagnose adjudicated AHF and echo-bnp AHF were up to four times greater using LDCT (cOR: 3.89 [2.15, 7.06] and cOR: 2.52 [1.45, 4.38], respectively). For each radiologic sign of pulmonary congestion, the LDCT provided superior or equivalent results as the chest radiographs, and the interrater agreement was higher using LDCT (kappa 0.88 [95% CI: 0.81, 0.95] vs. 0.73 [95% CI: 0.63, 0.82]). As first-line imaging modality, LDCT will find one additional adjudicated AHF in 12.5 patients and prevent one false-positive in 20 patients. Similar results were demonstrated for echo-bnp AHF.
CONCLUSIONS: In consecutive dyspnoeic patients admitted to the emergency department, LDCT is significantly better than chest radiographs in detecting pulmonary congestion.