Document Detail

Utility of a bedside acoustic cardiographic model to predict elevated left ventricular filling pressure.
MedLine Citation:
PMID:  20515905     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The authors previously described an acoustic cardiographic model that predicted echocardiographic correlates of elevated left ventricular (LV) filling pressure. This study evaluated this bedside acoustic cardiographic model against invasive measurements of LV filling pressure.
METHODS AND RESULTS: Data were prospectively obtained from 68 adults referred for right heart catheterisation. Acoustic cardiographic measurements were obtained during right heart catheterisation. Elevated LV filling pressure was defined as a pulmonary capillary wedge pressure (PCWP) > or =15 mm Hg. Parameters generated from a previous dataset used for the current analysis were measures of LV systolic time, maximum negative area of the P wave, QTc interval and third heart sound (S3) score. Logistic regression was used to calculate area under the curve (AUC). Of the 66 patients included, 39 had elevated PCWP. Estimating the probability of an elevated PCWP from the derived model resulted in an AUC of 0.72 (95% CI 0.60 to 0.85). When the regression model's parameters were held constant but the parameter estimates were allowed to vary, the AUC in the validated model was 0.76 (95% CI 0.64 to 0.88). At a specificity of 90% the positive likelihood ratio (LR+) was 5.0 (1.7 to 15.3) and the negative likelihood ratio was 0.49 (0.34 to 0.71).
CONCLUSION: These data demonstrate that the four-variable model predicts elevated filling pressure at the bedside with high specificity and an intermediate LR+. With improvements in sensitivity and further prospective validation of this model in a cohort of emergency department patients with undifferentiated dyspnoea this may be a useful bedside diagnostic modality.
Sean P Collins; Michael C Kontos; Andrew D Michaels; Michel Zuber; Peter Kipfer; Christine Attenhofer Jost; Marcus Roos; Paul Jamshidi; Paul Erne; Christopher J Lindsell
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Publication Detail:
Type:  Journal Article     Date:  2010-06-01
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  27     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-27     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  677-82     Citation Subset:  IM    
University of Cincinnati, Department of Emergency Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0769, USA.
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MeSH Terms
Aged, 80 and over
Blood Pressure
Cohort Studies
Electrocardiography / methods
Heart Catheterization
Heart Failure / physiopathology,  ultrasonography*
Logistic Models
Middle Aged
Models, Cardiovascular
Point-of-Care Systems*
Sensitivity and Specificity
Ventricular Dysfunction, Left / physiopathology,  ultrasonography*

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