Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.
Clin Cardiol. 2021 Jul;44(7):932-937. doi: 10.1002/clc.23615. Epub 2021 Jun 2.
Rapid diagnosis of heart failure (HF) in acutely dyspneic patients can be challenging for emergency department (ED) physicians.
Cardiac output (CO) change with sublingual nitroglycerin (NTG) could be helpful in the diagnosis of HF in patients with acute undifferentiated dyspnea.
A prospective study of patients >18 years admitted to the ED for acute dyspnea. Using thoracic bioimpedance, we measured CO change at baseline and after sublingual administration of 0.6 mg of NTG. HF was defined on the basis of clinical examination, pro-brain natriuretic peptide levels, and echocardiographic findings. Diagnostic performance of delta CO was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve.
This study included 184 patients with mean age of 64 years. Baseline CO was comparable between the HF group and the non-HF group. At its best cutoff (29%), delta CO showed good accuracy in the diagnosis of HF with a sensitivity, specificity, positive and negative likelihood ratios of 80%, 44%, 57%, and 66% respectively. Area under ROC curve was 0.701 [95% CI 0.636-0.760]. The decrease of CO with sublingual NTG was significantly higher in patients with HFpEF compared with those with HFrEF. Multivariate analysis, showed that delta CO was an independent factor associated with HF diagnosis [OR 0.19 (95% CI 0.11-0.29); p < .001].
Our study showed that CO change with sublingual nitroglycerin is a simple tool that may be helpful for the diagnosis of HF in ED patients with undifferentiated dyspnea.
急诊科（ED）医生快速诊断急性呼吸困难的心力衰竭（HF）具有挑战性。
舌下含服硝酸甘油（NTG）后心输出量（CO）的变化有助于诊断急性未分化呼吸困难患者的 HF。
一项对因急性呼吸困难而入住 ED 的 >18 岁患者进行的前瞻性研究。使用胸部生物阻抗法，我们在基线和舌下给予 0.6mg NTG 后测量 CO 的变化。HF 根据临床检查、脑利钠肽前体水平和超声心动图结果定义。通过敏感性、特异性、似然比和受试者工作特征（ROC）曲线计算Δ CO 的诊断性能。
本研究纳入了 184 名平均年龄为 64 岁的患者。HF 组和非 HF 组的基线 CO 无差异。在最佳截断值（29%）下，Δ CO 在 HF 的诊断中具有良好的准确性，其敏感性、特异性、阳性和阴性似然比分别为 80%、44%、57%和 66%。ROC 曲线下面积为 0.701 [95%CI 0.636-0.760]。HFpEF 患者舌下含服 NTG 后 CO 下降明显高于 HFrEF 患者。多变量分析显示，Δ CO 是与 HF 诊断相关的独立因素[OR 0.19（95%CI 0.11-0.29）；p<0.001]。
我们的研究表明，舌下含服硝酸甘油后 CO 的变化是一种简单的工具，可能有助于 ED 中诊断不明呼吸困难的 HF 患者。
