Internal and Emergency Medicine

, Volume 12, Issue 6, pp 861–869 | Cite as

Which method is best for an early accurate diagnosis of acute heart failure? Comparison between lung ultrasound, chest X-ray and NT pro-BNP performance: a prospective study

  • Stefano SartiniEmail author
  • Jacopo Frizzi
  • Matteo Borselli
  • Elisabetta Sarcoli
  • Carolina Granai
  • Veronica Gialli
  • Gabriele Cevenini
  • Gianni Guazzi
  • Fulvio Bruni
  • Stefano Gonnelli
  • Marcello Pastorelli


Acute heart failure is a common condition among adults presenting with dyspnea in the Emergency Department (ED), still the diagnosis is challenging as objective standardized criteria are lacking. First line work-up, other then clinical findings, is nowadays made with lung ultrasound imaging study, chest X-ray study and brain natriuretic peptide (BNP) level determination; however, it is not clear which is the best diagnostic test to be used and whether there is any real benefit for clinical judgement. We set up this study to compare the performances of these three diagnostic tools; furthermore, we combined them to find the best possible approach to dyspneic patients. This is a prospective observational study based in the ED. We enrolled adults presenting with dyspnea not trauma-related, they underwent lung ultrasound, and chest X-ray studies, and NT pro-BNP level determination. Then we compared the results with the diagnosis of acute heart failure established by an independent panel of experts. 236 patients were enrolled in the study. We find sensitivity and specificity for lung ultrasound of 57.73 and 87.97 %, for chest X-ray 74.49 and 86.26 %, for NT pro-BNP 97.59 and 27.56 %, respectively. Combining together the chest X-ray and lung ultrasound, we find the best overall performance with 84.69 % sensitivity, 77.69 % specificity and 87.07 % negative predictive value. From our results, we could not identify the “best test” to diagnose acute heart failure in an emergency setting, although we could suggest that a stepwise workup combining chest X-ray and lung ultrasound at first, then for those negative, a determination of NT pro-BNP assay would be a reasonable approach to the dyspneic patient.


Diagnosis Heart failure Natriuretic peptides Ultrasound Dyspnea Chest X-ray 


Compliance with ethical standards

Conflict of interest

There are no conflict of interest for all authors.

Statement of human and animal rights

The study was performed in accordance to the Declaration of Helsinki and approved by our local ethics committee. The study was registered by the Local Ethics Committee of the University Hospital of Siena and also registered in (Identifier NCT02122640).

Informed consent

Written informed consent was obtained from all subjects.


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Copyright information

© SIMI 2016

Authors and Affiliations

  • Stefano Sartini
    • 1
    • 9
    Email author return OK on get
  • Jacopo Frizzi
    • 2
  • Matteo Borselli
    • 3
  • Elisabetta Sarcoli
    • 4
  • Carolina Granai
    • 5
  • Veronica Gialli
    • 5
  • Gabriele Cevenini
    • 6
  • Gianni Guazzi
    • 7
  • Fulvio Bruni
    • 5
  • Stefano Gonnelli
    • 8
  • Marcello Pastorelli
    • 5
  1. 1.IRCCS AOU San MartinoGenoaItaly
  2. 2.Emergency DepartmentHospital of LuccaLuccaItaly
  3. 3.Emergency DepartmentSan Bortolo Hospital of VicenzaVicenzaItaly
  4. 4.Emergency DepartmentHospital of GrossetoGrossetoItaly
  5. 5.Emergency DepartmentUniversity Hospital of SienaSienaItaly
  6. 6.Medical Biotechnology DepartmentUniversity of SienaSienaItaly
  7. 7.Department of Emergency RadiologyUniversity Hospital of SienaSienaItaly
  8. 8.Internal Medicine DepartmentUniversity Hospital of SienaSienaItaly
  9. 9.ArezzoItaly

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