Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting

Table 2 Univariate analysis for all demographic and clinical variables pertinent to diagnosis of acute HF or pulmonary disease (N = 218)^a

Variables^b	Pulmonary-related dyspnea (n= 89)	Acute HF-related dyspnea (n= 129)	P value^c
Mean age, yr (± SD)	52.3 ± 15.3	70.9 ± 11.7	0.001
Sex, males/females (%)	176/87 (67%)	1,158/421 (73%)	0.74
Nocturnal dyspnea, Y/N	6/83	1/2	< 0.001
Orthopnea, Y/N	7/82	13/30	< 0.001
Cough, Y/N	17/41	34/95	< 0.001
Sputum production, Y/N	24/65	8/121	< 0.001
Fever, Y/N	21/68	7/122	< 0.001
Murmur, Y/N	8/81	29/100	< 0.001
Rales, Y/N	10/79	217/53	< 0.001
Wheezes, Y/N	12/3	47/82	< 0.001
Mean pulse rate, beats/min (± SD)	115.7 ± 14.1	106.3 ± 12.8	0.564
Jugular venous distension, Y/N	3/86	10/33	< 0.001
Lower extremity edema, Y/N	12/77	62/67	< 0.001
ECG-normal sinus rhythm, Y/N	210/17	55/72	< 0.001
Asthma/COPD medications, Y/N	65/11	13/116	< 0.001
HF medications, Y/N	33/56	245/46	< 0.001
Troponin T > 0.03 ng/mL, Y/N	8/81	49/80	< 0.001
Mean petCO₂, kPa (± SD)	6.9 ± 1.6	3.6 ± 1.1	0.01
Mean NT-proBNP, pg/mL (± SD)	598.2 ± 361.8	2,263 ± 641.2	0.008
Mean SaO₂, % (± SD)	75.7 ± 10.1	67.9 ± 12.8	0.76
Ultrasound examination-positive, Y/N	5/84	129/0	< 0.001
Previous arrhythmia, Y/N	7/82	52/77	< 0.001
Previous AMI, Y/N	7/82	15/28	< 0.001
Previous CHF, Y/N	17/72	233/49	< 0.001
Previous asthma/COPD, Y/N	169/19	9/34	< 0.001
ETI, Y/N	3/86	10/119	< 0.001
Mean modified Boston criteria score for diagnosing HF^d (± SD)	4.6 ± 1.2	10.9 ± 1.8	< 0.001

^aY, yes; N, no; petCO₂, partial pressure of end-tidal carbon dioxide; NT-proBNP, amino terminal pro-brain natriuretic peptide; ECG, electrocardiogram; HF, heart failure; CHF, congestive heart failure; AMI, acute myocardial infarction; SaO₂, arterial oxygen saturation; ETI, endotracheal intubation; COPD, chronic obstructive pulmonary disease. ^bResults are presented as means ± standard deviation for normally distributed data or ratio or percentage for other variables. ^cUnivariate comparison was made using the χ² test for categorical variables and a t-test for continuous variables. For evaluation of diagnostic accuracy, patients were divided into two groups: HF-related acute dyspnea and pulmonary-related acute dyspnea (COPD/asthma). ^dModified Boston criteria according to Table 1 and Remes et al. [6].

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