• Logo
  • SBMUJournals

Bedside Ultrasonography versus Brain Natriuretic Peptide in Detecting Cardiogenic Causes of Acute Dyspnea

Keihan Golshani, Mehrdad Esmailian, Aniseh Valikhany, Majid Zamani



Acute dyspnea is a common cause of hospitalization in emergency departments (ED).Distinguishing the cardiac causes of acute dyspnea from pulmonary ones is a major challenge for responsible physicians in EDs. This study compares the characteristics of bedside ultrasonography with serum level of blood natriuretic peptide (BNP) in this regard. Methods: This diagnostic accuracy study compares bedside ultrasonography with serum BNP levels in differentiating cardiogenic causes of acute respiratory distress. Echocardiography was considered as the reference test. A checklist including demographic data (age and sex), vital signs, medical history, underlying diseases, serum level of BNP, as well as findings of chest radiography, chest ultrasonography, and echocardiography was filled for all patients with acute onset of dyspnea. Screening characteristics of the two studied methods were calculated and compared using SPSS software, version 20. Results: 48 patients with acute respiratory distress were evaluated (50% female). The mean age of participants was 66.94 ± 16.33 (28-94) years. Based on the results of echocardiography and final diagnosis, the cause of dyspnea was cardiogenic in 20 (41.6%) cases. Bedside ultrasonography revealed the cardiogenic cause of acute dyspnea in 18 cases (0 false positive) and BNP in 44 cases (24 false positives). The area under the ROC curve for bedside ultrasonography and BNP for differentiating the cardiogenic cause of dyspnea were 86.4 (95% CI: 74.6-98.3) and 66.3 (95% CI: 49.8-89.2), respectively (p = 0.0021). Conclusion: It seems that bedside ultrasonography could be considered as a helpful and accurate method in differentiating cardiogenic causes of acute dyspnea in emergency settings. Nevertheless, more study is needed to make a runaway algorithm to evaluate patients with respiratory distress using bedside ultrasonography, which leads to rapid therapeutic decisions in a short time.


Ultrasonography; natriuretic peptide, brain; dyspnea; echocardiography; emergency service, hospital


Gargani L, Frassi F, Soldati G, Tesorio P, Gheorghiade M, Picano E. Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: A comparison with natriuretic peptides. European journal of heart failure. 2008;10(1):70-7.

Fonseca C, Oliveira AG, Mota T, et al. Evaluation of the performance and concordance of clinical questionnaires for the diagnosis of heart failure in primary care. European journal of heart failure. 2004;6(6):813-20.

Peacock WF. The evolving role of BNP in the diagnosis and treatment of CHF: a summary of the BNP consensus panel report. Emergency Medicine Cardiac Research and Education Group International (1). 2005.

Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovascular Ultrasound. 2008;6(1):16.

Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O. The comet-tail artifact: an ultrasound sign of alveolar-interstitial syndrome. American Journal of Respiratory and Critical Care Medicine. 1997;156(5):1640-6.

Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. Jama. 1989;261(6):884-8.

Soldati G, Copetti R, Sher S. Sonographic interstitial syndrome the sound of lung water. Journal of Ultrasound in Medicine. 2009;28(2):163-74.

Ziskin M, Thickman D, Goldenberg N, Lapayowker M, Becker J. The comet tail artifact. Journal of Ultrasound in Medicine. 1982;1(1):1-7.

Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? Jama. 2005;294(15):1944-56.

Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161-7.

McCullough PA, Nowak RM, McCord J, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation. 2002;106(4):416-22.

Doust JA, Glasziou PP, Pietrzak E, Dobson AJ. A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure. Arch Intern Med. 2004;164(18):1978-84.

Arques S, Roux E, Sbragia P, et al. Usefulness of Bedside Tissue Doppler Echocardiography and B‐Type Natriuretic Peptide (BNP) in Differentiating Congestive Heart Failure from Noncardiac Cause of Acute Dyspnea in Elderly Patients with a Normal Left Ventricular Ejection Fraction and Permanent, Nonvalvular Atrial Fibrillation: Insights from a Prospective, Monocenter Study. Echocardiography. 2007;24(5):499-507.

Davis M, Espiner E, Yandle T, et al. Plasma brain natriuretic peptide in assessment of acute dyspnoea. The Lancet. 1994;343(8895):440-4.

Morrison LK, Harrison A, Krishnaswamy P, Kazanegra R, Clopton P, Maisel A. Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. Journal of the American College of Cardiology. 2002;39(2):202-9.

Cabanes L, Richaud-Thiriez B, Fulla Y, et al. Brain natriuretic peptide blood levels in the differential diagnosis of dyspnea. CHEST Journal. 2001;120(6):2047-50.

Berdagué P, Caffin P-Y, Barazer I, et al. Use of N-terminal prohormone brain natriuretic peptide assay for etiologic diagnosis of acute dyspnea in elderly patients. American heart journal. 2006;151(3):690-8.

Lainchbury JG, Campbell E, Frampton CM, Yandle TG, Nicholls MG, Richards AM. Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. Journal of the American College of Cardiology. 2003;42(4):728-35.

Zanobetti M, Poggioni C, Pini R. Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED? CHEST Journal. 2011;139(5):1140-7.

Ang S-H, Andrus P. Lung ultrasound in the management of acute decompensated heart failure. Current cardiology reviews. 2012;8(2):123.

Kajimoto K, Madeen K, Nakayama T, Tsudo H, Kuroda T, Abe T. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting. Cardiovasc Ultrasound. 2012;10(1):49.

Lichtenstein D, Meziere G. A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med. 1998;24(12):1331-4.

Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134(1):117-25.

Gargani L. Lung ultrasound: a new tool for the cardiologist. Cardiovascular ultrasound. 2011;9(1):6.

DOI: https://doi.org/10.22037/emergency.v4i3.9993


  • There are currently no refbacks.