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Publications

Journal Article Epublish

PubMed: 42824627 DOI: 10.1016/j.ijcha.2026.102015

Diagnostic imaging modalities in Dyspnoea and suspected acute heart failure: a systematic review with Meta-analysis.

Int J Cardiol Heart Vasc 67:102015

Authors: Anne Sophie Overgaard Olesen, Kristina Miger, Ida Arentz Taraldsen, Jasmin Lukoschewitz, Emilie Melgaard, Emma Malm, Sandra Tonning, Lucas Westergaard, Simone Haastrup, Mohammed El-Sheikh, Olav Wendelboe Nielsen, Jens Jakob Thune, Pardeep S Jhund, Alasdair D Henderson, Janus Christian Jakobsen, Johannes Grand

Affiliations

  • Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
  • Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  • British Heart Foundation Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom.
  • Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.
  • Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
  • Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.

Abstract

BACKGROUND

Early identification of pulmonary congestion in patients with dyspnoea is critical for managing acute heart failure. However, the optimal imaging modality remains uncertain. We compared chest radiography, lung ultrasound, computed tomography (CT), and remote dielectric sensing (ReDS) for detecting acute heart failure.

METHODS

We conducted a preregistered systematic review and meta-analysis of prospective observational studies in adults with dyspnoea. Medline, Embase, LILACS, and Web of Science were searched on April 9, 2025. Two reviewers independently screened studies, extracted data, and assessed bias. Sensitivity and specificity were pooled using bivariate random-effects models. Comparative performance was assessed by Bayesian network meta-analysis with weakly informative priors.

RESULTS

We included 95 studies (15,132 patients). Lung ultrasound was evaluated in 78 studies (11,790 patients), chest radiography in 30 (5966), CT in two (368), and ReDS in six (525). Some studies evaluated multiple modalities. Pooled sensitivity and specificity were 0.87 (95%CI: 0.82-0.90) and 0.89 (0.85-0.91) for lung ultrasound, 0.65 (0.58-0.72) and 0.91 (0.87-0.94) for chest radiography, 0.73 (0.53-0.87) and 0.73 (0.58-0.84) for ReDS. CT was not included in bivariate modelling because data were sparse; Bayesian network estimates were sensitivity 0.76 (95%CrI 0.62-0.86) and specificity 0.94 (0.88-0.97). CT and lung ultrasound each had >95% posterior probability of higher sensitivity than chest radiography and higher specificity than both chest radiography and ReDS.

CONCLUSION

Lung ultrasound may serve as a first-line bedside modality. A normal chest radiograph cannot reliably exclude acute heart failure. CT showed high specificity based on limited evidence. The role of ReDS remains uncertain.

MeSH

Lung, Heart Failure, Heart, Radiography, Diagnostic Imaging