The role of POCUS in diagnosing acute heart failure in the emergency department: A meta-analysis.

The role of point-of-care ultrasound (POCUS) in diagnosing acute heart failure is not fully established. We evaluated the diagnostic accuracy of cardiac, lung, and inferior vena cava (IVC) POCUS, individually and combined, in the emergency department (ED). We systematically searched PubMed, Embase, Web of Science, and Google Scholar for English-language studies published from inception to November 2024. Statistical analyses were conducted using STATA 16, and study quality was assessed with the QUADAS-2 tool. Fifteen studies involving 2751 dyspneic patients in the ED were included. Lung ultrasound demonstrated sensitivities of 72 % for B-lines ≥10, 79 % for bilateral B-pattern in two or more zones, and 100 % for pleural effusion, with specificities of 86 %, 82 %, and 75 %, respectively. Cardiac ultrasound revealed sensitivities of 70 % for the E/A ratio, 100 % for the E/e' ratio, and 63-82 % for varying left ventricular ejection fraction (LVEF) thresholds (<40 %, <45 %, <50 %), with specificities ranging from 76 % to 88 %. Plethoric IVC demonstrated a sensitivity of 100 % and a specificity of 25 %. The IVC collapsibility index (IVC-CI) <20 % and <50 % yielded sensitivities of 43 % and 83 % and specificities of 90 % and 81 %, respectively. Multiorgan ultrasound combining lung and cardiac findings achieved overall sensitivity of 78 % and specificity of 96 %. Combining bilateral B-pattern in two or more zones, MAPSE, E/A, and E/e' yielded 96 % sensitivity and 93 % specificity. The combination of LVEF and B-lines demonstrated 61 % sensitivity and 96 % specificity, while LVEF and bilateral B-pattern in two or more zones showed 70 % sensitivity and 93 % specificity. LVEF and pleural effusion showed a sensitivity of 91 % and a specificity of 99 %. Adding IVC to the combined lung and cardiac approach resulted in a specificity of 99 % but reduced sensitivity to 54 %. Conclusively, the lung, cardiac, and IVC ultrasounds, individually or combined, demonstrated consistently high specificity and moderately high sensitivity.