CORRELATIONOFB-LINESON LUNGULTRASOUND AND NT PRO BNP TODIFFERENTIATE BETWEEN ACUTE HEARTFAILURE FROM OTHER NON CARDIOGENICCAUSESOFDYSPNEA-APROSPECTIVEDIAGNOSTICSTUDY
Authors:   AssociateProfessor,EmergencyMedicineKIMSBengaluru., Byrappa Varun , Panchgar Vinayak ,   ProfessorandHead,DepartmentofAnaesthesiology,GIMS Gadag., Bhandi Shivaraddi ,   Assistant Professor, Department of Anaesthesiology, GIMS Gadag., S. Anagha ,   Post-Graduate, Departmentof Anaesthesiology, GIMS Gadag.
Published: July 2023

Background: Dyspnea can be a manifestation of a variety of clinical conditions like acuteheart failure (AHF), chronic obstructive pulmonary disease (COPD), pneumonia, pulmonaryembolism and asthma. Dyspnea can prove to be life threatening and therefore it is immenselyimportanttoinitiatethetreatmentattheearliest.Itis notuncommonfor patients topresentascombinationofvarious causes ofbreathingdifficulty. Infactitis oftenalmostimpossibletodiscriminate between cardiogenic and non cardiogenic causes of dyspnea on initialpresentation.A diagnosticaidwhichcanbeusedatthis very minuteofpresentationcanproveto be boon for emergency physicians to accurately recognize the cause and initiate thetreatment. We correlated the presence of B lines on lung USGand NT proBNP incardiogenicpulmonary edema. Methods: A diagnostic prospective study was done on patients of age more than 18 yearspresenting with acute dyspnea to the emergency department after obtaining informed consent.Lung ultrasound was done to look for B- lines and NT-Pro BNP samples were sent along withthe other investigations. More than 3 B-lines in the anterior surface of the chest presentbilaterally were taken as positive. NT pro BNP values above 900pg/ml were consideredsignificantly positive. Final diagnosis made by Cardiologist/Intensivist/Pulmonologist wasrecorded. Results: 65 patients presenting with symptoms of breathlessness were studied. 49 patients hadpresenceofB-linesonthelungUSGconstitutingabout75.4%ofthepatients.Basedonhistory,clinicalexamination,initialdiagnosisofcardiogenicdyspneawasmadein50.8%of49patientswith B profile. Out of the 49 patients with positive B lines, 40 patients were finally diagnosedwith cardiac failure by cardiologists/ intensivists with a sensitivity of B- lines to diagnosecardiac failure is 90.91%, specificity is 57.14%, Positive predictive value is 81.63% andNegative Predictive value is 75%. The data analysis showed that out of 49 subjects who had Bprofile of the lung, 44 patients had positive NT pro BNP values above 900pg/ml. However, A-profileof thelungwaspresentinallthepatientswithNTproBNPvaluesmorethan900pg/ml.ThemeanNT-proBNPin thepatientshavingB-profilewas8182.47whileitwas251.69inthepatientshavingA-profileofthelung.Wefoundgoodassociation andcorrelationbetweenthetwovariables.AreaunderthecurvesuggestedbothlungUSGandNTproBNPhadgoodandsimilar diagnosticaccuracy. Conclusion: In acute onset of dyspnea, presence of B-lines on Lung Ultrasound has very goodsensitivity to diagnose acute heart failure. The diagnostic accuracy increases if there are 4-5B-lines present bilaterally on Lung Ultrasound. It has a strong correlation with raised NT- proBNP levels in diagnosis Acute Heart Failure. If the number of B-lines on Lung Ultrasoundincreases, thevalueof NT-pro BNP also increases.