| Use of hand carried ultrasound, B-type natriuretic peptide, and clinical assessment in identifying abnormal left ventricular filling pressures in patients referred for right heart catheterization. | |
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MedLine Citation:
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PMID: 20123321 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The estimation of left ventricular filling pressure (LVFP) remains a critical component in the management of patients with known or suspected acute heart failure syndromes. Although right heart catheterization (RHC) remains the gold standard, several noninvasive parameters, including clinical assessment, B-type natriuretic peptides (BNP), and echocardiography can approximate LVFP. We sought to use a combination of these measures to noninvasively predict high or low LVFP in a population referred for RHC. METHODS AND RESULTS: The study consisted of validation of hand-carried ultrasound (HCU)-derived measurement of mitral E/E' against standard echocardiograms in 50 patients, as well as direct comparison of jugular venous pressure (JVP), a clinical congestion score, HCU-derived E/E' and maximum inferior vena cava diameter (IVCmax), and BNP with pulmonary capillary wedge pressure (PCWP) in another 50 patients. The mean age was 61 years, ejection fraction 40%, JVP 9 cm, BNP 948 pg/mL, IVCmax 2.1 cm, E/E' 13, and PCWP 21. All parameters performed well in determining PCWP >or=15 mm Hg, with clinical score performing the worst (area under the receiver-operator characteristic curve [AUC] 0.74), and IVCmax performing the best (AUC 0.89). JVP, in combination with HCU-derived parameters and BNP performed better than any of the individual tests alone (AUC 0.97 for combination of all 3). CONCLUSIONS: Clinical score, JVP, HCU indices, and BNP perform well at identifying patients with a PCWP >or=15 mm Hg. Use of these indices alone or in combination can be used to identify and potentially monitor patients with high LVFP in the inpatient and outpatient settings. |
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Authors:
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Sascha N Goonewardena; John E A Blair; Amin Manuchehry; J Matthew Brennan; Michael Keller; Ryan Reeves; Adam Price; Kirk T Spencer; Jyothy Puthumana; Mihai Gheorghiade |
Publication Detail:
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Type: Comparative Study; Journal Article; Validation Studies Date: 2009-09-26 |
Journal Detail:
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Title: Journal of cardiac failure Volume: 16 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2010-02-03 Completed Date: 2010-09-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 69-75 Citation Subset: IM |
Affiliation:
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University of Michigan, Ann Arbor, MI. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Biological Markers / blood Echocardiography, Transesophageal / instrumentation Female Heart Catheterization* / methods Heart Failure / blood, diagnosis, ultrasonography* Humans Male Middle Aged Natriuretic Peptide, Brain / blood* Prospective Studies Pulmonary Wedge Pressure / physiology Referral and Consultation* Syndrome Ultrasonography / instrumentation* Ventricular Dysfunction, Left / blood, diagnosis, ultrasonography* |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 114471-18-0/Natriuretic Peptide, Brain |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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