Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFS |
Texto Completo: | https://ri.ufs.br/handle/riufs/3778 |
Resumo: | Acute dyspnea (AD) is a common complaint in a hospital unit and frequently, differential diagnosis is a challenge despite acquirement of diverse methodologies. Lung ultrasonography (LU) has shown useful identifying AD of cardiogenic origin. However, there is a shortage of national studies confirming such quality. Objectives: Evaluate LU’s contribution on identification of cardiogenic origin AD. Methodology: This is a prospective, longitudinal cohort of patients in emergency room and admitted into hospital unit, with AD complaint. They were evaluated by Framingham risk score (FRS) for cardiac insufficiency (CI) and subjected to the following additional tests: electrocardiogram (ECG), chest radiography (CR), transthoracic ecodoppler cardiogram (TTE) and LU. Excluded pulmonary fibrosis and lung neoplasm patients. Calculated: sensitivity, specificity, positive and negative predictive value, as well as ROC curve of LU for AD diagnosis. Interobserver agreement among methods was estimated by kappa statistic. Results: From February to October of 2015, 118 patients (9 excluded) were classified according to presence or absence of CI by FRS. 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(IPE) on LU, CI to CR criteria (p=0.009) and, on TTE, higher E/e’ ratio (p=0.002) and left ventricle diastolic dysfunction (p=0.04), besides lower ejection fraction (p=0.00). Importants predictors on IPE detection by US in these patients were male gender, diabetics and with ejection fraction of reduced(p=0.01; 0.02 and 0.03, respectively). 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 76.4% negative. Conclusion: therefore, concludes that LU proved to be a useful tool and with reproducibility when identifying AD of cardiogenic. |
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Araujo, Caroline de Souza CostaSousa, Antônio Carlos Sobralhttp://lattes.cnpq.br/42277741656146192017-09-26T12:17:20Z2017-09-26T12:17:20Z2016-03-29ARAÚJO, Caroline de Souza Costa. Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados. 2016. 74 f. Dissertação (Pós-Graduação em Ciências da Saúde) - Universidade Federal de Sergipe, São Cristóvão, 2016.https://ri.ufs.br/handle/riufs/3778Acute dyspnea (AD) is a common complaint in a hospital unit and frequently, differential diagnosis is a challenge despite acquirement of diverse methodologies. Lung ultrasonography (LU) has shown useful identifying AD of cardiogenic origin. However, there is a shortage of national studies confirming such quality. Objectives: Evaluate LU’s contribution on identification of cardiogenic origin AD. Methodology: This is a prospective, longitudinal cohort of patients in emergency room and admitted into hospital unit, with AD complaint. They were evaluated by Framingham risk score (FRS) for cardiac insufficiency (CI) and subjected to the following additional tests: electrocardiogram (ECG), chest radiography (CR), transthoracic ecodoppler cardiogram (TTE) and LU. Excluded pulmonary fibrosis and lung neoplasm patients. Calculated: sensitivity, specificity, positive and negative predictive value, as well as ROC curve of LU for AD diagnosis. Interobserver agreement among methods was estimated by kappa statistic. Results: From February to October of 2015, 118 patients (9 excluded) were classified according to presence or absence of CI by FRS. 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(IPE) on LU, CI to CR criteria (p=0.009) and, on TTE, higher E/e’ ratio (p=0.002) and left ventricle diastolic dysfunction (p=0.04), besides lower ejection fraction (p=0.00). Importants predictors on IPE detection by US in these patients were male gender, diabetics and with ejection fraction of reduced(p=0.01; 0.02 and 0.03, respectively). 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 76.4% negative. Conclusion: therefore, concludes that LU proved to be a useful tool and with reproducibility when identifying AD of cardiogenic.A dispneia aguda (DA) é uma queixa frequente em unidade hospitalar e o diagnóstico diferencial torna-se desafiador a despeito da aquisição de diferentes metodologias aplicadas. A ultrassonografia pulmonar (UP) tem-se demonstrado útil na identificação de DA de origem cardiogênica. Todavia, há poucos estudos nacionais ratificando esse benefício. Objetivos: Avaliar a contribuição da UP na identificação de DA de origem cardiogênica. Metodologia: Trata-se de uma coorte, prospectiva, longitudinal, de pacientes em pronto-socorro e internos em unidade hospitalar, com queixa principal de DA. Foram avaliados pelo escore de Framingham (EF) para insuficiência cardíaca(IC) e submetidos aos seguintes exames complementares: eletrocardiograma(ECG), radiografia de tórax (RT), ecodopplercardiograma transtorácico(ETT) e UP. Excluídos os portadores de fibrose ou neoplasia pulmonar. Foram calculados os parâmetros de sensibilidade, especificidade, valor preditivo positivo e negativo, assim como a curva ROC da UP para o diagnóstico de DA. Concordância inter-observador entre métodos foi estimada pelo método kappa. Resultados: De fevereiro a outubro/2015, 118 pacientes (9 excluídos) foram classificados quanto a presença ou não de IC pelo EF. Dos 109 casos, 60(55%) tinham IC. Esses eram mais idosos (idade média 76±16.7, p=0.01), homens (60%, p=0.004), hipertensos (83%, p=0.01), diabéticos (50.8%, p=0.03), com insuficiência renal crônica (IRC)(32.2%, p=0.03), maior graduação de Killip adaptada(p=0.00) e classe funcional(p=0.003). Apresentaram mais edema intersticial pulmonar(EIP) à UP (p=0.00), critérios de IC à RT (p=0.009) e, ao ETT, maiores relação E/e’(p=0.002) e disfunção diastólica do ventrículo esquerdo(p=0.04), além de menor fração de ejeção(p=0.00). Os preditores independentes na detecção de EIP pela US nesses pacientes foram o sexo masculino, diabéticos e com fração de ejeção reduzida(p=0.01; 0.02 e 0.03, respectivamente). Houve razoável concordância kappa (k) entre UP com EF(k=0.25) e RT(k=0.22) para IC e moderada da UP(k: 0.48) e RT(k:0.44) inter-observador. A sensibilidade da UP para EIP em pacientes com IC foi 90.91%, especificidade 65%, valor preditivo positivo 85.1% e preditivo negativo de 76.4%. Conclusão: Conclui-se que a UP demonstrou ser ferramenta útil e com reprodutibilidade na identificação de DA de origem cardiogênica.application/pdfporUniversidade Federal de SergipePós-Graduação em Ciências da SaúdeUFSBrasilCiências da saúdeCongestão pulmonarDispneiaInsuficiência cardíacaUltrassonografia pulmonarLung congestionDyspneaCardiac insufficiencyLung ultrasonographyCIENCIAS DA SAUDEUltrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizadosLung ultrasonography identifying acute cardiogenic dyspnea in hospitalized patientsinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFSinstname:Universidade Federal de Sergipe (UFS)instacron:UFSTEXTCAROLINE_SOUZA_COSTA_ARAUJO.pdf.txtCAROLINE_SOUZA_COSTA_ARAUJO.pdf.txtExtracted texttext/plain148076https://ri.ufs.br/jspui/bitstream/riufs/3778/2/CAROLINE_SOUZA_COSTA_ARAUJO.pdf.txtba959f0fd6103ade851667055a368dfcMD52THUMBNAILCAROLINE_SOUZA_COSTA_ARAUJO.pdf.jpgCAROLINE_SOUZA_COSTA_ARAUJO.pdf.jpgGenerated Thumbnailimage/jpeg1212https://ri.ufs.br/jspui/bitstream/riufs/3778/3/CAROLINE_SOUZA_COSTA_ARAUJO.pdf.jpg2f703ffd9a3fe56f41b71762e5c96863MD53ORIGINALCAROLINE_SOUZA_COSTA_ARAUJO.pdfapplication/pdf1410870https://ri.ufs.br/jspui/bitstream/riufs/3778/1/CAROLINE_SOUZA_COSTA_ARAUJO.pdfde842bc8de53506054ae1b04156e8894MD51riufs/37782017-11-28 17:03:05.891oai:ufs.br:riufs/3778Repositório InstitucionalPUBhttps://ri.ufs.br/oai/requestrepositorio@academico.ufs.bropendoar:2017-11-28T20:03:05Repositório Institucional da UFS - Universidade Federal de Sergipe (UFS)false |
dc.title.por.fl_str_mv |
Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados |
dc.title.alternative.eng.fl_str_mv |
Lung ultrasonography identifying acute cardiogenic dyspnea in hospitalized patients |
title |
Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados |
spellingShingle |
Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados Araujo, Caroline de Souza Costa Ciências da saúde Congestão pulmonar Dispneia Insuficiência cardíaca Ultrassonografia pulmonar Lung congestion Dyspnea Cardiac insufficiency Lung ultrasonography CIENCIAS DA SAUDE |
title_short |
Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados |
title_full |
Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados |
title_fullStr |
Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados |
title_full_unstemmed |
Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados |
title_sort |
Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados |
author |
Araujo, Caroline de Souza Costa |
author_facet |
Araujo, Caroline de Souza Costa |
author_role |
author |
dc.contributor.author.fl_str_mv |
Araujo, Caroline de Souza Costa |
dc.contributor.advisor1.fl_str_mv |
Sousa, Antônio Carlos Sobral |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4227774165614619 |
contributor_str_mv |
Sousa, Antônio Carlos Sobral |
dc.subject.por.fl_str_mv |
Ciências da saúde Congestão pulmonar Dispneia Insuficiência cardíaca Ultrassonografia pulmonar |
topic |
Ciências da saúde Congestão pulmonar Dispneia Insuficiência cardíaca Ultrassonografia pulmonar Lung congestion Dyspnea Cardiac insufficiency Lung ultrasonography CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
Lung congestion Dyspnea Cardiac insufficiency Lung ultrasonography |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
Acute dyspnea (AD) is a common complaint in a hospital unit and frequently, differential diagnosis is a challenge despite acquirement of diverse methodologies. Lung ultrasonography (LU) has shown useful identifying AD of cardiogenic origin. However, there is a shortage of national studies confirming such quality. Objectives: Evaluate LU’s contribution on identification of cardiogenic origin AD. Methodology: This is a prospective, longitudinal cohort of patients in emergency room and admitted into hospital unit, with AD complaint. They were evaluated by Framingham risk score (FRS) for cardiac insufficiency (CI) and subjected to the following additional tests: electrocardiogram (ECG), chest radiography (CR), transthoracic ecodoppler cardiogram (TTE) and LU. Excluded pulmonary fibrosis and lung neoplasm patients. Calculated: sensitivity, specificity, positive and negative predictive value, as well as ROC curve of LU for AD diagnosis. Interobserver agreement among methods was estimated by kappa statistic. Results: From February to October of 2015, 118 patients (9 excluded) were classified according to presence or absence of CI by FRS. 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(IPE) on LU, CI to CR criteria (p=0.009) and, on TTE, higher E/e’ ratio (p=0.002) and left ventricle diastolic dysfunction (p=0.04), besides lower ejection fraction (p=0.00). Importants predictors on IPE detection by US in these patients were male gender, diabetics and with ejection fraction of reduced(p=0.01; 0.02 and 0.03, respectively). 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 76.4% negative. Conclusion: therefore, concludes that LU proved to be a useful tool and with reproducibility when identifying AD of cardiogenic. |
publishDate |
2016 |
dc.date.issued.fl_str_mv |
2016-03-29 |
dc.date.accessioned.fl_str_mv |
2017-09-26T12:17:20Z |
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2017-09-26T12:17:20Z |
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masterThesis |
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dc.identifier.citation.fl_str_mv |
ARAÚJO, Caroline de Souza Costa. Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados. 2016. 74 f. Dissertação (Pós-Graduação em Ciências da Saúde) - Universidade Federal de Sergipe, São Cristóvão, 2016. |
dc.identifier.uri.fl_str_mv |
https://ri.ufs.br/handle/riufs/3778 |
identifier_str_mv |
ARAÚJO, Caroline de Souza Costa. Ultrassonografia pulmonar na identificação da dispneia aguda cardiogênica em pacientes hospitalizados. 2016. 74 f. Dissertação (Pós-Graduação em Ciências da Saúde) - Universidade Federal de Sergipe, São Cristóvão, 2016. |
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