Research Laboratory LR12SP18, University of Monastir, Tunisia.
Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia.
Int J Clin Pract. 2020 Oct;74(10):e13572. doi: 10.1111/ijcp.13572. Epub 2020 Aug 27.
The diagnosis of heart failure in the emergency department (ED) is challenging. The aim of this study was to evaluate systolic time intervals (STIs) using phonoelectrocardiography for the diagnosis of heart failure (HF) in ED patients with undifferentiated dyspnea.
A total of 855 patients with dyspnea and suspected HF were prospectively enrolled. They underwent echocardiographic measurements of left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP) testing and computerised phonoelectrocardiography to assess STIs including electromechanical activation time (EMAT), left ventricular ejection time (LVET) and EMAT/LVET ratio. Diagnosis accuracy of STIs was calculated including sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve.
Patients with HF (n = 530) had significantly higher EMAT and lower LVET compared with non-HF patients. ROC curve c-statistic was 0.74, 0.72 and 0.78 for EMAT, LVET and EMAT/LVET respectively. Sensitivity and specificity of EMAT/LVET at a cut-off = 40% were 72% and 88% respectively. EMAT/LVET had the highest correlation with LVEF (r = 0.48). In patients with intermediate BNP (n = 107), positive likelihood ratio increased from 1.8 with BNP alone to 3.6 with BNP combined to EMAT/LVET. Patients without HF had STIs values not significantly different from those with preserved LVEF (≥45%).
Given their immediate availability, phonoelectrocardiography STIs' parameters and particularly EMAT/LVET ratio could have an important role in the diagnosis approach of HF in patients with undifferentiated dyspnea in the ED.
急诊科（ED）心力衰竭的诊断具有挑战性。本研究旨在评估使用 phonoelectrocardiography 对 ED 呼吸困难且病因未明的心力衰竭（HF）患者进行收缩时间间隔（STI）以诊断 HF。
共前瞻性纳入 855 例呼吸困难且疑似 HF 的患者。他们接受了左心室射血分数（LVEF）超声心动图测量、B 型利钠肽（BNP）检测和计算机化 phonoelectrocardiography 以评估 STI，包括机电激活时间（EMAT）、左心室射血时间（LVET）和 EMAT/LVET 比值。计算 STI 的诊断准确性，包括灵敏度、特异性、似然比和接收者操作特征（ROC）曲线。
HF 患者（n=530）的 EMAT 显著高于非 HF 患者，LVET 显著低于非 HF 患者。EMAT、LVET 和 EMAT/LVET 的 ROC 曲线 C 统计量分别为 0.74、0.72 和 0.78。EMAT/LVET 截断值为 40%时的灵敏度和特异性分别为 72%和 88%。EMAT/LVET 与 LVEF 的相关性最高（r=0.48）。在中间 BNP（n=107）患者中，阳性似然比从 BNP 单独时的 1.8 增加到 BNP 与 EMAT/LVET 联合时的 3.6。无 HF 患者的 STI 值与 LVEF 正常（≥45%）患者无显著差异。
鉴于其即时可用性，phonoelectrocardiography STI 参数，尤其是 EMAT/LVET 比值，在 ED 呼吸困难且病因未明的 HF 患者的诊断方法中可能具有重要作用。
