Hemodynamic changes as a diagnostic tool in acute heart failure-a pilot study

RS Engineer, JL Benoit, CW Hicks, SJ Kolattukudy, D Burkhoff and WF Peacock
Am.J.Emerg.Med. 2010:Epub ahead of print

OBJECTIVES: To examine whether posturally induced changes in cardiac output differentiate patients presenting with dyspnea to the emergency department (ED) with acute heart failure (AHF) from other causes. METHODS: This was an observational study of patients presenting to the ED with dyspnea. Exclusion criteria included ischemic chest pain, electrocardiographic changes diagnostic of acute myocardial infarction, pericardial effusion or chest wall deformities causing dyspnea, or heart transplant. Hemodynamic variables of cardiac index (CI), total peripheral resistance index, and thoracic fluid content (TFC) were determined in upright seated and supine positions 3 minutes apart using bioreactance technology (Cheetah Medical Inc, Portland, Ore). Acute heart failure was defined as either B-type natriuretic peptide 100 to 500 pg/mL and discharge diagnosis of AHF or a B-type natriuretic peptide greater than 500 pg/mL. RESULTS: Of 92 patients, 25 had AHF, 23 had asthma/chronic obstructive pulmonary disease (COPD), and 44 had dyspnea related to other conditions; 41 (44.1%) were male, 56 (60.2%) were African American, and the mean age was 58 +/- 15.0 years. Mean baseline TFC was higher in AHF vs asthma/COPD (59.3 +/- 26.0 vs 39.7 +/- 14.8 1/kW, P = .003) and trended higher compared to other patients with dyspnea (49.2 +/- 22.0, P = .10). Postural changes in mean CI were lower in AHF (-0.20 +/- 0.84 L min(-1) m(-2)) vs asthma/COPD (1.20 +/- 1.23 L min(-1) m(-2); P = .002) and other dyspnea patients (0.82 +/- 0.91 L min(-1) m(-2); P = .007). CONCLUSION: Patients with AHF have greater TFC but lower CI responses to postural changes compared to patients with asthma and COPD. Knowledge of these changes may help rapidly differentiate AHF from asthma and COPD in the ED.

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