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Original Research: Signs and Symptoms of Chest Diseases |

Noninvasive Assessment of Acute Dyspnea in the EDAssessment of Dyspnea in the ED

Xaime García, MD; Peter Simon, MD; Francis X. Guyette, MD; Ravi Ramani, MD; Rene Alvarez, MD; Jorge Quintero, MD; and Michael R. Pinsky, MD, FCCP
Author and Funding Information

From the Department of Critical Care Medicine (Drs García, Simon, and Pinsky), University of Pittsburgh, Pittsburgh, PA; Department of Intensive Care Medicine (Dr García), Hospital of Sabadell, CIBER Enfermedades Respiratorias, Institut Universitari Parc Taulí–Autonomous, University of Barcelona, Sabadell, Spain; and Department of Emergency Medicine (Drs Guyette and Quintero) and Department of Cardiovascular Diseases (Drs Ramani and Alvarez), University of Pittsburgh, Pittsburgh, PA.

Correspondence to: Michael R. Pinsky, MD, FCCP, 606 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261; e-mail: pinskymr@upmc.edu


This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted use, distribution, and reproduction to noncommercial entities, provided the original work is properly cited. Information for reuse by commercial entities is available online.

Funding/Support: This work was supported in part by National Institutes of Health [Grants HL67181 and HL073198].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):610-615. doi:10.1378/chest.12-1676
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Background:  We compared the ability of noninvasive measurements of cardiac output (CO) and thoracic fluid content (TFC) and their change in response to orthostatic challenges to diagnose acute decompensate heart failure (ADHF) from non-ADHF causes of acute dyspnea in patients in the ED.

Methods:  Forty-five patients > 44 years old presenting in the ED with dyspnea were studied. CO and TFC were monitored with a NICOM bioreactance device. CO and TFC were measured continuously while each patient was sitting, supine, and during a passive leg-raising maneuver (3 min each); the maximal values during each maneuver were reported. Orthostatic challenges were repeated 2 h into treatment. One patient was excluded because of intolerance to the supine position. Diagnoses obtained with the hemodynamic measurements were compared with ED diagnoses and with two expert physicians by chart review (used as gold standard diagnosis); both groups were blinded to CO and TFC values. Patient’s treatment, ED disposition, hospital length of stay, and subjective dyspnea (Borg scale) were also recorded.

Results:  Sixteen of 44 patients received a diagnosis of ADHF and 28 received a diagnosis of non-ADHF by the experts. Baseline TFC was higher in patients with ADHF (P = .001). Fifteen patients were treated for ADHF, and their Borg scale values decreased at 2 h (P < .05). TFC threshold of 78.8 had a receiver operator characteristic area under the curve of 0.81 (76% sensitivity, 71% specificity) for ADHF. Both ADHF and non-ADHF groups were similar in their increased CO from baseline to PLR and supine. Pre- and posttreatment measurements were similar.

Conclusions:  Baseline TFC can discriminate patients with ADHF from non-ADHF dyspnea in the ED.

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