Occult Perfusion Deficits in Heart Failure Patients: Indentification Through Non-Invasive Central Hemodynamic Monitoring

Milzman, David; Morrisey, John Morrisey; Napoli, Anthony M.

doi:10.1097/00003246-199912001-00228

Cited by 5 publications

(3 citation statements)

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“…Impedance cardiography (ICG) is a validated, noninvasive method of determining hemodynamic parameters 5–8 . Previous studies of ICG have demonstrated utility in the differential diagnosis of dyspnea, 9,10 the prediction of hospital charges and length of stay, 11 and the ability to change the real‐time diagnosis and treatment decisions in dyspneic patients 12…”

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confidence: 99%

Utility of Impedance Cardiography to Determine Cardiac vs. Noncardiac Cause of Dyspnea in the Emergency Department

Springfield

Sebat

Johnson

et al. 2004

Congestive Heart Failure

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Determining the correct diagnosis of patients with dyspnea can be challenging. Early and accurate determination of the cause of dyspnea is vital in instituting timely and appropriate interventions. Hemodynamic parameters may aid in the evaluation of dyspnea, but are difficult to assess by physical exam. Impedance cardiography (ICG) is a newly validated method of determining hemodynamic parameters noninvasively. The purpose of this study was to determine the accuracy in differentiating cardiac from noncardiac causes of dyspnea utilizing ICG-derived hemodynamic parameters compared with that of emergency department (ED) physicians after initial history, physical, and laboratory tests. The final diagnosis, which was made retrospectively after review of the patient's hospital record by a senior ED physician blinded to the ICG data, was compared with the treating ED physician's and the ICG diagnoses. Thirty-eight patients who presented with dyspnea to a community ED were included in the study. There were significant differences in values of cardiac index by ICG (2.2 vs. 3.1; p<0.0001), systolic time ratio (0.52 vs. 0.37; p<0.01) and velocity index (32.9 vs. 42.7; p<0.01) between the cardiac and noncardiac groups, respectively. ICG measurements demonstrated greater sensitivity (92 vs. 83%), specificity (88 vs. 77%), and positive and negative predictive values (79 vs. 63% and 96 vs. 91%, respectively) compared with the ED physician in distinguishing cardiac from noncardiac cause of dyspnea. ICG can aid ED physicians in making more rapid and accurate determinations of cardiac vs. noncardiac cause of dyspnea.

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confidence: 99%

Utility of Impedance Cardiography to Determine Cardiac vs. Noncardiac Cause of Dyspnea in the Emergency Department

Springfield

Sebat

Johnson

et al. 2004

Congestive Heart Failure

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“…ICG has also been shown to have some prognostic use in the ED setting. In 50 heart failure patients presenting to an urban ED setting, an initial low CI (CI <2.2 L/min/m 2 ) or a low stroke volume (SI <60 mL) was associated with an increased length of stay and increased hospital charges when compared with CHF patients with normal central hemodynamic values 34 . Another study of 58 CHF patients presenting to an ED demonstrated that patients with an increased CI after 60 minutes of resuscitation trended toward both a reduced hospital stay and hospital charges compared with patients without an improved CI 35…”

Section: Discussionmentioning

confidence: 98%

Combination of B‐Type Natriuretic Peptide Levels and Non‐Invasive Hemodynamic Parameters in Diagnosing Congestive Heart Failure in the Emergency Department

Barcarse

Kazanegra

Chen

et al. 2004

Congestive Heart Failure

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This study aimed to assess whether the combination of a B‐type natriuretic peptide (BNP) level with various noninvasive hemodynamic parameters can help physicians more quickly and accurately diagnose congestive heart failure and determine the type of left ventricular dysfunction present in patients presenting to the emergency department with dyspnea. Subjects were 98 men (aged 64.57±1.23 years) that presented to the VA San Diego Healthcare System. Hemodynamic parameters were measured using impedance cardiography, and BNP levels were quantified using a rapid immunoassay. All patients with a BNP <100 pg/mL (n=37) had no evidence of congestive heart failure 97% of the time. In those with a BNP >100 pg/mL (601 ±55 pg/mL; n=61), a cardiac index of 2.6 L/min/m2 is 65% sensitive and 88% specific in determining systolic dysfunction. In patients with a BNP >100 pg/mL, a multivariate model consisting of noninvasive hemodynamic measurements was able to predict cardiac deaths, readmissions, and emergency department visits within 90 days with 83% accuracy. The authors conclude that, in patients presenting to an emergency department with dyspnea, the addition of impedance cardiography measurements to BNP level measurements will more effectively diagnose congestive heart failure and determine both the type of heart dysfunction and the severity of illness.

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“…11 In the ED setting, ICG has been studied for the differential diagnosis of dyspnea [12][13][14] and the identification of pulmonary edema 15,16 and provides prognostic information about hospitalization costs and length of stay. 17 ICG results are available within a few minutes, allowing more rapid patient evaluation than that afforded by radiographic or laboratory studies.…”

mentioning

confidence: 99%

Impact of Impedance Cardiography on Diagnosis and Therapy of Emergent Dyspnea: The ED‐IMPACT Trial

Peacock

Summers

Vogel

et al. 2006

Academic Emergency Medicine

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Occult Perfusion Deficits in Heart Failure Patients: Indentification Through Non-Invasive Central Hemodynamic Monitoring

Cited by 5 publications

References 0 publications

Utility of Impedance Cardiography to Determine Cardiac vs. Noncardiac Cause of Dyspnea in the Emergency Department

Utility of Impedance Cardiography to Determine Cardiac vs. Noncardiac Cause of Dyspnea in the Emergency Department

Combination of B‐Type Natriuretic Peptide Levels and Non‐Invasive Hemodynamic Parameters in Diagnosing Congestive Heart Failure in the Emergency Department

Impact of Impedance Cardiography on Diagnosis and Therapy of Emergent Dyspnea: The ED‐IMPACT Trial

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