ABC | Volume 110, Nº6, June 2018

Review Article Muniz et al Pulmonary ultrasound in patients with heart failure Arq Bras Cardiol. 2018; 110(6):577-584 Databases Medline (n = 1015) Lilacs (n = 239) (n = 78 articles) (n = 54 articles) (n = 26 articles) Excluded for not relating to the study theme: Medline (n = 960) Lilacs (n = 216) 12 duplicate articles 12 articles (letter, editorials, case report, methodological description) Other exclusions: Animals (n = 5) Reviews (n = 10) Abstract (n = 5) Other languages (n = 8) Figure 3 – Structured search according to the PRISMA model of systematic reviews. In two distinct studies, Platz et al. 21,22 have concluded that the clip duration is more important than the type of device used to analyze B-lines, and that the number of B-lines correlate with right atrial pressures, diastolic and systolic pulmonary artery pressures and central venous pressure, but correlated with neither pulmonary artery occlusion pressure nor cardiac index. In our initial experience, pulmonary congestion detected on PU correlated better with SPAP than with EDD, 86% and 58%, respectively. Pulmonary ultrasound and diagnostic assessment A study has identified pleural effusion in 100% of the patients with decompensated HF in the prehospital setting, 13 and another by Prosen et al. 18 has concluded that PU can differentiate cardiac from pulmonary dyspnea, mainly when associating with the use of BNP, observing an increase in diagnostic sensitivity and specificity for the association of PU and BNP. In the emergency setting, Pivetta et al. 23 have observed an increase in diagnostic accuracy, with reclassification of the diagnosis in 19% of the patients after PU. Russel et al. 24 have found a change in treatment in the acute phase of around 47% of the cases. Gallard et al. 25 have reported an accuracy of 90% when PU was compared to the clinical examination (67%, p = 0.001), as well as compared to the combination of clinical examination with NT-proBNP and chest X-ray (81%, p = 0.04). Oskan et al., 26 when comparing the diagnostic performance of PU and auscultation for the diagnosis of decompensatedHF and pneumonia, have found sensitivity of 100% and 89% vs. 75% and 73%, respectively. Gullet et al. 16 and Chiem et al. 17 have found agreement between the little or newly trained observer and the highly trained observer in the interobserver analysis for the diagnosis of patients with dyspnea in the emergency setting. Regarding the diagnosis of decompensated HF in patients with dyspnea in the emergency setting, Anderson et al. 27 have found similar values for PU (S = 70%) and BNP > 500 pg/mL (S = 75%). Martindale et al. 28 have reported the superiority of PU (74%) versus chest X-ray (58%) in the global agreement with the gold-standardmethod for the diagnosis of pulmonary edema. Kajimoto et al. 29 have reported that inferior vena cava (IVC) ultrasound associated with PU increases diagnostic sensitivity in acute HF versus primary pulmonary disease. Jang et al. 30 have reported that the longitudinal and cross-sectional measures of the internal jugular vein at the end of exhalation is a sensitive test to identify pulmonary edema on chest X-ray in patients with suspected HF. Liteplo et al. 31 have reported the superiority of PU as compared to NT-proBNP to differentiate chronic HF from chronic obstructive pulmonary disease with a positive likelihood ratio (LR)(+) of 3.88 (99% CI = 1.55 – 9.73), while NT-proBNP had a LR(+) of 2.3 (95% CI = 1.41 – 3.76). 579