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Jugular Venous Pressure Response to Inspiration for Risk Assessment of Heart Failure. Am J Cardiol 2022; 170:71-75. [PMID: 35277252 DOI: 10.1016/j.amjcard.2022.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/01/2022] [Accepted: 01/17/2022] [Indexed: 11/23/2022]
Abstract
Simplifying jugular venous pressure (JVP), visibility of the right internal jugular vein above the right clavicle in the sitting position, has been proposed in the management of heart failure (HF) because of its convenience. However, this method may be undervalued for the detection of mildly to moderately increased JVP. Increased JVP on inspiration, known as Kussmaul sign, may be a useful physical finding in this condition. This study consisted of 138 patients who were admitted for the management of HF. Using this simple method, JVP was assessed at rest in the sitting position before discharge; its response to inspiration was also examined if no high JVP was noted at rest. The primary outcome was a composite of cardiac death and hospitalization for worsening HF. Among all the patients, 16 patients (12%) had high JVP at rest and another 16 patients (12%) had high JVP not at rest but on inspiration. During a follow-up period of 249 ± 182 days, a primary outcome event occurred in 63 patients (46%). The incidence of adverse cardiac events was higher in patients with a high JVP at rest (69%; hazard ratio 3.31, 95% confidence interval 1.64 to 6.67, p = 0.0009) and in patients with a high JVP on inspiration (56%; hazard ratio 2.18, 95% confidence interval 1.02 to 4.63, p = 0.043) than in patients without a high JVP in both conditions (41%). In conclusion, a high JVP not only at rest but also on inspiration was associated with a poor prognosis. The response of JVP to inspiration using this simple technique of physical examination may be a new approach in the management of HF.
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Hidaka T, Sumimoto Y, Dohi Y, Morimoto H, Susawa H, Nitta K, Ishibashi K, Kurisu S, Fukuda Y, Hashimoto H, Matsui S, Kishimoto S, Kajikawa M, Maruhashi T, Ukawa T, Goto C, Nakashima A, Noma K, Tsuji T, Kihara Y, Higashi Y. Non-Invasive Central Venous Pressure Measurement Using Enclosed-Zone Central Venous Pressure (ezCVP TM). Circ J 2020; 84:1112-1117. [PMID: 32418957 DOI: 10.1253/circj.cj-20-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Central venous pressure (CVP) is measured to assess intravascular fluid status. Although the clinical gold standard for evaluating CVP is invasive measurement using catheterization, the use of catheterization is limited in a clinical setting because of its invasiveness. We developed novel non-invasive technique, enclosed-zone (ezCVPTM) measurement for estimating CVP. The purpose of this study was to assess the feasibility of ezCVP and the relationship between ezCVP and CVP measured by a catheter.Methods and Results:We conducted 291 measurements in 97 patients. Linear regression analysis revealed that ezCVP was significantly correlated with CVP (r=0.65, P<0.0001). The Bland-Altman analysis showed that ezCVP had an underestimation bias of -2.5 mmHg with 95% limits of agreement of -14.1 mmHg and 9.6 mmHg for CVP (P<0.0001). The areas under the curves of receiver operating curve with ezCVP to detect the CVP ≥12 cmH2O (8.8 mmHg) and CVP >10 mmHg were 0.81 or 0.88, respectively. The sensitivity, specificity and positive likelihood ratio of ezCVP for the CVP ≥8.8 mmHg and CVP >10 mmHg were 0.59, 0.96 and 14.8 with a cut-off value of 11.9 and 0.79, 0.97 and 26.3 with a cut-off value of 12.7. CONCLUSIONS These findings suggest that ezCVP measurement is feasible and useful for assessing CVP.
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Affiliation(s)
- Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Yoji Sumimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Yoshihiro Dohi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | | | - Hitoshi Susawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Satoru Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Haruki Hashimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Shogo Matsui
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Shinji Kishimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Masato Kajikawa
- Division of Regeneration and Medicine, Hiroshima University Hospital
| | - Tatsuya Maruhashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | | | | | - Ayumu Nakashima
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Kensuke Noma
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Toshio Tsuji
- Graduate School of Engineering, Hiroshima University
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Science
| | - Yukihito Higashi
- Division of Regeneration and Medicine, Hiroshima University Hospital.,Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
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Ambulatory Monitoring of Heart Sounds via an Implanted Device Is Superior to Auscultation for Prediction of Heart Failure Events. J Card Fail 2020; 26:151-159. [DOI: 10.1016/j.cardfail.2019.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/30/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
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4
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Werner M, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig JM, Masyuk M, Schulze PC, Hoppe UC, Kelm M, Lauten A, Jung C. Real-world extravascular lung water index measurements in critically ill patients : Pulse index continuous cardiac output measurements: time course analysis and association with clinical characteristics. Wien Klin Wochenschr 2019; 131:321-328. [PMID: 31069475 DOI: 10.1007/s00508-019-1501-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/16/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pulse index continuous cardiac output (PiCCO) is used for hemodynamic assessment. This study describes real world extravascular lung water index (EVLWI) measurements at three time points and relates them to other hemodynamic parameters and mortality in critically ill patients admitted to a medical intensive care unit (ICU). METHODS A total of 198 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis. Patients were admitted for various diseases such as sepsis (n = 22), myocardial infarction (n = 53), pulmonary embolism (n = 3), cardiopulmonary resuscitation (n = 15), acute heart failure (AHF; n = 21) and pneumonia (n = 25). RESULTS Patients included in this analysis were severely ill as represented by the high simplified acute physiology score 2 (SAPS2, 42 ± 18) and acute physiology and chronic health evaluation score 2 (APACHE2' 22 ± 9). Real-world values at three time points are provided. Intra-ICU mortality rates did not differ between the EVLWI > 7 vs. the ELVWI < 7 groups (15% vs. 13%; p = 0.82) and no association between hemodynamic measurements obtained by PiCCO with long-term mortality could be shown. CONCLUSION There were no associations of any PiCCO measurements with mortality most probably due to selection bias towards severely ill patients. Future prospective studies with predefined inclusion criteria and treatment algorithms are necessary to evaluate the value of PiCCO for prediction of mortality against simple clinical tools such as jugular venous pressure, edema and auscultation.
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Affiliation(s)
- Matthias Werner
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Bjoern Kabisch
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Johanna M Muessig
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Paul Christian Schulze
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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5
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Thibodeau JT, Drazner MH. The Role of the Clinical Examination in Patients With Heart Failure. JACC-HEART FAILURE 2018; 6:543-551. [PMID: 29885957 DOI: 10.1016/j.jchf.2018.04.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 10/14/2022]
Abstract
Despite advances in biomarkers and technology, the clinical examination (i.e., a history and physical examination) remains central in the management of patients with heart failure. Specifically, the clinical examination allows noninvasive assessment of the patient's underlying hemodynamic state, based on whether the patient has elevated ventricular filling pressures and/or an inadequate cardiac index. Such assessments provide important prognostic information and help guide therapeutic decision-making. Herein, the authors critically assess the utility of the clinical examination for these purposes and provide practical tips we have gleaned from our practice in the field of advanced heart failure. The authors note that the ability to assess for congestion is superior to that for inadequate perfusion. Furthermore, in current practice, elevated left ventricular filling pressures are inferred by findings related to an elevated right atrial pressure. They discuss an emerging classification system from the clinical examination that categorizes patients based on whether elevation of ventricular filling pressures occurs on the right side, left side, or both sides.
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Affiliation(s)
- Jennifer T Thibodeau
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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Kim MS, Lee JH, Kim EJ, Park DG, Park SJ, Park JJ, Shin MS, Yoo BS, Youn JC, Lee SE, Ihm SH, Jang SY, Jo SH, Cho JY, Cho HJ, Choi S, Choi JO, Han SW, Hwang KK, Jeon ES, Cho MC, Chae SC, Choi DJ. Korean Guidelines for Diagnosis and Management of Chronic Heart Failure. Korean Circ J 2017; 47:555-643. [PMID: 28955381 PMCID: PMC5614939 DOI: 10.4070/kcj.2017.0009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022] Open
Abstract
The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea.
The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.
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Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eung Ju Kim
- Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Hyun Ihm
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Pyeongchon Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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7
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Wang S, Liu M, Fang F, Shang Q, Sun JP, Sanderson JE, Yu CM. Prognostic value of acoustic cardiography in patients with chronic heart failure. Int J Cardiol 2016; 219:121-6. [DOI: 10.1016/j.ijcard.2016.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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8
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Bank I, Vliegen HW, Bruschke AVG. The 200th anniversary of the stethoscope: Can this low-tech device survive in the high-tech 21st century? Eur Heart J 2016; 37:3536-3543. [PMID: 26908946 DOI: 10.1093/eurheartj/ehw034] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/15/2015] [Accepted: 01/21/2016] [Indexed: 11/14/2022] Open
Abstract
In 1816, Laennec discovered that auscultation of the heart and lungs could effectively be performed by placing a hollow cylinder (initially made of a roll of paper) between the chest of the patient and the ear of the examiner. This was the first step in the development of the stethoscope, which was a breakthrough in the diagnosis and management of cardiac and pulmonary patients. Technical improvements of the stethoscope followed and in cardiac patients auscultation soon became a major diagnostic tool. In the second half of the 20th century, new powerful non-invasive diagnostic modalities were developed and the interest in auscultation declined. As a result, the auscultatory skills of students and physicians at all levels of training decreased to a disappointingly low level. We now must decide whether we should stimulate the use of and proficiency in auscultation or if we should accept the further decline and eventual abolishment of this component of the physical examination. Reviewing the literature and taking into consideration the setting in which the patients are presented, including the availability of advanced diagnostic facilities, we conclude that the time-honoured stethoscope, in spite of its limitations, still has potential as a patient-friendly, effective, and economical instrument in medical practice. However, new initiatives are required to train students, physicians and allied health professionals in cardiac auscultation to avoid misinterpretations that may harm the patients and generate extra costs. To be successful such programs will require wide support from the medical community.
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Affiliation(s)
- Ivan Bank
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, Lange Land Hospital, Zoetermeer, The Netherlands
| | - Hubert W Vliegen
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Albert V G Bruschke
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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10
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Minami Y, Kajimoto K, Sato N, Aokage T, Mizuno M, Asai K, Munakata R, Yumino D, Murai K, Hagiwara N, Mizuno K, Kasanuki H, Takano T. Third heart sound in hospitalised patients with acute heart failure: insights from the ATTEND study. Int J Clin Pract 2015; 69:820-8. [PMID: 25521285 DOI: 10.1111/ijcp.12603] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Several previous studies have suggested that detection of a third heart sound (S3) in patients with chronic congestive heart failure is associated with adverse long-term outcomes. However, the short-term prognostic value of identifying an S3 on admission in patients with acute heart failure (AHF) is not well established. We therefore analysed the in-hospital prognostic value of detecting an S3 on admission in hospitalised patients with AHF. METHODS The Acute Decompensated Heart Failure Syndromes (ATTEND) study investigators enrolled 4107 patients hospitalised with AHF. Investigators evaluated the presence or absence of an S3 during routine physical examination. RESULTS On admission to hospital, 1673 patients (41%) had an S3. Patients with an S3 had a higher heart rate, higher serum level of B-type natriuretic peptide and higher creatinine levels than patients without an S3. However, there were no significant differences of systolic blood pressure, serum sodium, haemoglobin, C-reactive protein and total bilirubin between the two groups. Multivariate analysis adjusted for various markers of disease severity revealed that only the presence of an S3 was independently associated with an increase of in-hospital all cause death [adjusted odds ratio (OR), 1.69; 95% confidence interval (CI), 1.19-2.41; p = 0.003] and cardiac death (adjusted OR, 1.66; 95% CI, 1.08-2.54; p = 0.020) among the congestive physical findings related to heart failure (S3, rales, jugular venous distension and peripheral oedema). CONCLUSIONS Detecting an S3 on admission was independently associated with adverse in-hospital outcomes in patients with AHF. Our findings suggest that careful bedside assessment is clinically meaningful.
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Affiliation(s)
- Y Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Kajimoto
- Department of Cardiology, Sensoji Hospital, Tokyo, Japan
| | - N Sato
- Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - T Aokage
- Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan
| | - M Mizuno
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Asai
- Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - R Munakata
- Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan
| | - D Yumino
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Murai
- Intensive and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan
| | - N Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Mizuno
- Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - H Kasanuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - T Takano
- Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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11
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Beyond auscultation: Acoustic cardiography in clinical practice. Int J Cardiol 2014; 172:548-60. [DOI: 10.1016/j.ijcard.2013.12.298] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 11/24/2022]
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12
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Wang S, Fang F, Liu M, Lam YY, Wang J, Shang Q, Sun JP, Sanderson JE, Yu CM. Rapid bedside identification of high-risk population in heart failure with reduced ejection fraction by acoustic cardiography. Int J Cardiol 2013; 168:1881-6. [DOI: 10.1016/j.ijcard.2012.12.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/21/2012] [Accepted: 12/25/2012] [Indexed: 11/16/2022]
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13
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Practice Guidelines for the Diagnosis and Management of Systolic Heart
Failure in Low- and Middle-Income Countries. Glob Heart 2013; 8:141-70. [DOI: 10.1016/j.gheart.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Abstract
Longstanding experimental evidence supports the role of renal venous hypertension in causing kidney dysfunction and "congestive renal failure." A focus has been heart failure, in which the cardiorenal syndrome may partly be due to high venous pressure, rather than traditional mechanisms involving low cardiac output. Analogous diseases are intra-abdominal hypertension and renal vein thrombosis. Proposed pathophysiologic mechanisms include reduced transglomerular pressure, elevated renal interstitial pressure, myogenic and neural reflexes, baroreceptor stimulation, activation of sympathetic nervous and renin angiotensin aldosterone systems, and enhanced proinflammatory pathways. Most clinical trials have addressed the underlying condition rather than venous hypertension per se. Interpreting the effects of therapeutic interventions on renal venous congestion are therefore problematic because of such confounders as changes in left ventricular function, cardiac output, and blood pressure. Nevertheless, there is preliminary evidence from small studies of intense medical therapy or extracorporeal ultrafiltration for heart failure that there can be changes to central venous pressure that correlate inversely with renal function, independently from the cardiac index. Larger more rigorous trials are needed to definitively establish under what circumstances conventional pharmacologic or ultrafiltration goals might best be directed toward central venous pressures rather than left ventricular or cardiac output parameters.
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15
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Chuen MJNK, Lip GYH, MacFadyen RJ. Repeated assessment of physical biomeasures or blood biomarkers for the definition of volume status and cardiac loading in LVSD. Biomark Med 2012; 1:355-74. [PMID: 20477380 DOI: 10.2217/17520363.1.3.355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The application of biomarker technology can be usefully implemented in areas where current techniques are inadequate and where a clinical issue, which affects outcome, can be defined. The definition of the loading status of the heart where there is pre-existent impairment of contractile function is a key target. Heart failure is a complex clinical presentation with many varied etiologies, but at the essence of its successful management is the reliable definition of cardiac volume loading. Traditional and many current technological measures are applied to define this relationship, yet their accuracy and performance in individual patients is either basically inadequate or poorly understood and applied. There is a wide range of both physical measurements and blood biomarkers that can be considered to better define this key issue in patients with ventricular systolic impairment. Their performance is considered in detail in this review.
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DJEBBARI ABDELGHANI, BEREKSI-REGUIG F. SMOOTHED-PSEUDO WIGNER–VILLE DISTRIBUTION OF NORMAL AND AORTIC STENOSIS HEART SOUNDS. J MECH MED BIOL 2011. [DOI: 10.1142/s0219519405001552] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, we are interested in the acquisition and the time-frequency analysis of the Phonocardiogram (PCG) signal. The interactive software "PCG Recorder" we implemented in MATLAB, drives the sound card of a personal computer for acquisition purposes. Normal and abnormal heart sounds were acquired with 16 bits resolution and at high sampling frequencies; the value 2 kHz was selected as sampling rate to avoid spectral aliasing. For each patient, additional information like the age, the gender, the weight as well as the auscultation area can be introduced within the saved data file. The aortic, the tricuspid, the mitral and the pulmonic areas are considered for the acquisition task. The Smoothed-Pseudo Wigner–Ville Distribution (SPWVD) yield adequate Time-Frequency Representations (TFRs) of such non-stationary signal as heart sounds. Moreover, by taking into account the corresponding auscultation area for each obtained TFR, we adopt exclusion reasoning to attribute each burst to its origins within the myocardium. Furthermore, the alternating functioning of heart valves and cavities in systole and diastole was characterized in the time and frequency domains. Aortic stenosis heart sounds were involved in our study in a view to confirm their pathological nature towards the normal heart sounds findings. Indeed, the weakened S1 and S2 heart sounds and the strong systolic ejection murmur which dominates the overall systole, confirm our hypotheses. Thus, modulations laws relating to the systolic ejection of blood through the stenosed orifice were characterized by means of the reliable SPWVD approach. A third heart sound (S3) which is an indicator of the presence of systolic dysfunction and the elevated filling pressure for aortic stenosis lesion was also characterized.
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Affiliation(s)
- ABDELGHANI DJEBBARI
- Laboratory of Biomedical Engineering, Faculty of Engineering Sciences, University Abou Bekr Belkaïd, B. P. 119, Tlemcen, Algeria
| | - F. BEREKSI-REGUIG
- Laboratory of Biomedical Engineering, Faculty of Engineering Sciences, University Abou Bekr Belkaïd, B. P. 119, Tlemcen, Algeria
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Amoozgar H, Ajami GH, Borzuoee M, Amirghofran AA, Ebrahimi P. Peripheral venous pressure as a predictor of central venous pressure in continuous monitoring in children. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:342-5. [PMID: 22737491 PMCID: PMC3371973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/15/2010] [Accepted: 11/10/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Measurement of central venous pressure (CVP) is a reliable method for evaluating intravascular volume status and cardiac function; however it is an invasive and expensive method that may result in some complications such as arterial puncture, pneumothorax and development of infections. This study was performedto compare CVP measurements between central and peripheral catheters in infant and children with congenital heart disease. METHODS The CVP and peripheral venous pressure (PVP) were measured simultaneously in 30 patients within 10 consecutive hours. RESULTS The mean difference between CVP and PVP was 1.48±0.98 mmHg. The linear regression equation showed that CVP was 0.374+0.774 PVP (r(2) = 0.725). CONCLUSION PVP measured from a peripheral intravenous catheter in infants and children with congenital heart disease is an accurate estimation of CVP and its changes has good concordance with CVP over a long period of time.
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Affiliation(s)
- H Amoozgar
- Department of Pediatrics, Division of Pediatric Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Hamid Amoozgar, MD, Department of Pediatrics, Nemazee Hospital, Shiraz University of Medical Sciencezs,7193711351, Shiraz, Iran. Tel.: +98-711-6474298, Fax: +98-711-6474298, E-mail:
| | - Gh H Ajami
- Department of Pediatrics, Division of Pediatric Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Borzuoee
- Department of Pediatrics, Division of Pediatric Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A A Amirghofran
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P Ebrahimi
- Department of Pediatrics, Division of Pediatric Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Kosmicki DL, Collins SP, Kontos MC, Zuber M, Kipfer P, Attenhofer Jost C, Michaels AD. Noninvasive Prediction of Left Ventricular Systolic Dysfunction in Patients With Clinically Suspected Heart Failure Using Acoustic Cardiography. ACTA ACUST UNITED AC 2010; 16:249-53. [DOI: 10.1111/j.1751-7133.2010.00191.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Uthoff H, Thalhammer C, Potocki M, Reichlin T, Noveanu M, Aschwanden M, Staub D, Arenja N, Socrates T, Twerenbold R, Mutschmann-Sanchez S, Heinisch C, Jaeger KA, Mebazaa A, Mueller C. Central venous pressure at emergency room presentation predicts cardiac rehospitalization in patients with decompensated heart failure. Eur J Heart Fail 2010; 12:469-76. [PMID: 20223880 DOI: 10.1093/eurjhf/hfq024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To investigate the relationship between central venous pressure (CVP) at presentation to the emergency room (ER) and the risk of cardiac rehospitalization and mortality in patients with decompensated heart failure (DHF). METHODS AND RESULTS Central venous pressure was determined non-invasively using high-resolution compression sonography at presentation in 100 patients with DHF. Cardiac hospitalizations and cardiac and all-cause mortality were assessed as a function of continuous CVP levels and predefined CVP categories (low <6 cm H(2)O, intermediate 6-23 cm H(2)O, and high >23 cm H(2)O). Endpoints were adjudicated blinded to CVP. At presentation, mean age was 78 +/- 11 years, 60% of patients were male, mean B-type natriuretic peptide level was 1904 +/- 1592 pg/mL, and mean CVP was 13.7 +/- 7.0 cm H(2)O (range 0-33). During follow-up (median 12 months), 25 cardiac rehospitalizations, 26 cardiac deaths, and 7 non-cardiac deaths occurred. Univariate and stepwise multivariate Cox regression analysis revealed an independent relationship between CVP and cardiac rehospitalization (HR 1.09, 95% CI 1.01-1.18, P = 0.034). Kaplan-Meier analyses confirmed a stepwise increase in cardiac rehospitalization for low-to-high CVP (log-rank test P = 0.015). No association between CVP and (cardiac) mortality was detectable. CONCLUSION Central venous pressure at ER presentation in patients with DHF is an independent predictor of cardiac rehospitalization but not of cardiac and all-cause mortality.
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Affiliation(s)
- Heiko Uthoff
- Department of Angiology, University Hospital, Basel, Switzerland
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21
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Shah SJ, Michaels AD. Hemodynamic correlates of the third heart sound and systolic time intervals. ACTA ACUST UNITED AC 2009; 12 Suppl 1:8-13. [PMID: 16894268 DOI: 10.1111/j.0889-7204.2006.05767.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bedside diagnostic tools remain important in the care of patients with heart failure. Over the past two centuries, cardiac auscultation and phonocardiography have been essential in understanding cardiac pathophysiology and caring for patients with heart disease. Diastolic heart sounds (S3 and S4) and systolic time intervals have been particularly useful in this regard. Unfortunately, auscultation skills have declined considerably, and systolic time intervals have traditionally required carotid pulse tracings. Newer technology allows the automated detection of heart sounds and measurement of systolic time intervals in a simple, inexpensive, noninvasive system. Using the newer system, the authors present data on the hemodynamic correlates of the S3 and abnormal systolic time intervals. These data serve as the foundation for using the system to better understand the test characteristics and pathophysiology of the S3 and systolic time intervals, and help to define their use in improving the bedside diagnosis and management of patients with heart failure.
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Affiliation(s)
- Sanjiv J Shah
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA
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22
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Peacock WF, Harrison A, Maisel AS. The utility of heart sounds and systolic intervals across the care continuum. ACTA ACUST UNITED AC 2009; 12 Suppl 1:2-7. [PMID: 16894267 DOI: 10.1111/j.0889-7204.2006.05766.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Acoustic cardiography is an exciting, new, easy-to-use, modernized technology that incorporates already proven techniques of phonocardiography. Application of acoustic cardiography to clinical practice can improve diagnosis and management of heart failure patients. Its clinical use should help address some of the need for robust, inexpensive, and widely accessible technology for proactive heart failure diagnosis and management. Acoustic cardiographically recorded measurements have been correlated with both cardiac catheterization and echocardiographically determined hemodynamic parameters. Heart sounds captured by acoustic cardiograms have proven to assist clinicians in assessing dyspneic patients in the emergency department by utilizing the strong specificity of an S3 for detecting acute decompensated heart failure. Acoustic cardiography offers a cost-efficient, easy-to-use method to optimize the devices used in cardiac resyncronization therapy. The rapidly and easily obtainable information gathered by acoustic cardiography should foster its more widespread use in diagnosis and treatment of heart failure, including cardiac resyncronization therapy device optimization.
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Affiliation(s)
- W Frank Peacock
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, USA
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Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased Central Venous Pressure Is Associated With Impaired Renal Function and Mortality in a Broad Spectrum of Patients With Cardiovascular Disease. J Am Coll Cardiol 2009; 53:582-588. [PMID: 19215832 DOI: 10.1016/j.jacc.2008.08.080] [Citation(s) in RCA: 651] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 08/12/2008] [Accepted: 08/18/2008] [Indexed: 12/23/2022]
Affiliation(s)
- Kevin Damman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Vincent M van Deursen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hans L Hillege
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LW, Russell SD, Young JB, Califf RM, Nohria A. Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial. Circ Heart Fail 2008; 1:170-7. [PMID: 19675681 PMCID: PMC2724723 DOI: 10.1161/circheartfailure.108.769778] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We determined whether estimated hemodynamics from history and physical examination (H&P) reflect invasive measurements and predict outcomes in advanced heart failure (HF). The role of the H&P in medical decision making has declined in favor of diagnostic tests, perhaps due to lack of evidence for utility. METHODS AND RESULTS We compared H&P estimates of filling pressures and cardiac index with invasive measurements in 194 patients in the ESCAPE trial. H&P estimates were compared with 6-month outcomes in 388 patients enrolled in ESCAPE. Measured right atrial pressure (RAP) was <8 mm Hg in 82% of patients with RAP estimated from jugular veins as <8 mm Hg, and was >12 mm Hg in 70% of patients when estimated as >12 mm Hg. From the H&P, only estimated RAP > or =12 mm Hg (odds ratio [OR] 4.6; P<0.001) and orthopnea > or =2 pillows (OR 3.6; P<0.05) were associated with pulmonary capillary wedge pressure (PCWP) > or =30 mm Hg. Estimated cardiac index did not reliably reflect measured cardiac index (P=0.09), but "cold" versus "warm" profile was associated with lower median measured cardiac index (1.75 vs. 2.0 L/min/m(2); P=0.004). In Cox regression analysis, discharge "cold" or "wet" profile conveyed a 50% increased risk of death or rehospitalization. CONCLUSIONS In advanced HF, the presence of orthopnea and elevated jugular venous pressure are useful to detect elevated PCWP, and a global assessment of inadequate perfusion ("cold" profile) is useful to detect reduced cardiac index. Hemodynamic profiles estimated from the discharge H&P identify patients at increased risk of early events.
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Affiliation(s)
- Mark H Drazner
- University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA.
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Tang WHW, Van Lente F, Shrestha K, Troughton RW, Francis GS, Tong W, Martin MG, Borowski AG, Jasper S, Starling RC, Klein AL. Impact of myocardial function on cystatin C measurements in chronic systolic heart failure. J Card Fail 2008; 14:394-9. [PMID: 18514931 DOI: 10.1016/j.cardfail.2008.01.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 11/21/2007] [Accepted: 01/11/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND The influence of myocardial function on plasma levels of cystatin C (CysC), a sensitive marker of renal function, in chronic systolic heart failure (HF) has not been well established. METHODS We prospectively identified 139 subjects with stable, chronic HF (left ventricular ejection fraction < or = 35%) and measured plasma levels of CysC. We prospectively tracked patients' long-term adverse clinical outcomes (death, cardiac transplantation, and HF hospitalizations). RESULTS Plasma levels of CysC were elevated in 41% of patients with preserved renal function and directly correlated with N-terminal prohormone brain natriuretic peptide (r = 0.57, P < .0001). There was a significant association between CysC and mitral E/septal E' ratio (r = 0.34, P < .001), right ventricular systolic dysfunction severity (r = 0.30, P < .001), and mitral regurgitation severity (r = 0.31, P < .001), but not left ventricular ejection fraction. At the cutoff of 1.23 mg/dL, CysC remains a significant independent risk factor for adverse clinical outcomes (hazard ratio 1.88, 95% confidence interval 1.15-3.09, P = .012) after adjusting for estimated glomerular filtration rate, left ventricular ejection fraction, and E/septal E'. CONCLUSION CysC is associated with more advanced left ventricular diastolic dysfunction and right ventricular systolic dysfunction and remains an independent predictor of long-term prognosis in chronic systolic HF after adjusting for myocardial factors.
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Affiliation(s)
- W H Wilson Tang
- Kaufman Center for Heart Failure, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Ohio 44195, USA
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Shah SJ, Marcus GM, Gerber IL, McKeown BH, Vessey JC, Jordan MV, Huddleston M, Foster E, Chatterjee K, Michaels AD. Physiology of the Third Heart Sound: Novel Insights from Tissue Doppler Imaging. J Am Soc Echocardiogr 2008; 21:394-400. [PMID: 17658724 DOI: 10.1016/j.echo.2007.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND The third heart sound (S(3)) is thought to be caused by the abrupt deceleration of left ventricular (LV) inflow during early diastole, increased LV filling pressures, and decreased LV compliance. We sought to determine whether the ratio of early mitral inflow velocity to diastolic velocity of the mitral annulus (E/E') could confirm the proposed mechanism of the S(3). METHODS A total of 90 subjects underwent phonocardiography, echocardiography, tissue Doppler imaging, and left-sided heart catheterization. RESULTS Phonocardiography detected an S(3) in 21 patients (23%). Subjects with an S(3) had lower ejection fraction (P = .0006) and increased E deceleration rate (P < .0001), E/E' (P < .0001) and filling pressures (P < .0001). The phonocardiographic S(3) confidence score correlated with E/E' (r = 0.46; P < .0001) and E deceleration rate (r = 0.43, P = .0001). Of the echocardiographic variables, only E/E' was independently associated with the S(3) confidence score (P = .009), independently of invasively determined LV filling pressures (P = .001). CONCLUSIONS The most important determinants of the pathologic S(3) are an increased deceleration rate of early mitral inflow, elevated LV filling pressures, and abnormal compliance of the myocardium as measured by tissue Doppler imaging.
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Affiliation(s)
- Sanjiv J Shah
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California, USA
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27
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Abstract
Dyspnea is a common presenting complaint in the emergency department (ED). Rapid identification of heart failure as the etiology leads to early implementation of targeted therapies. Although having only intermediate sensitivity, the S3 is a highly specific finding among older adults with heart failure. Identification of an S3 by routine auscultation can be problematic given the chaotic and noisy ED environment, patient comorbid conditions, and intolerance of ideal positioning for auscultation. Technologies using computerized analysis of digitally recorded heart tones have recently been developed to aid the clinician with bedside detection of abnormal heart sounds. Data using these technologies and their applications in the ED are reviewed as well as implications for future use and research.
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Affiliation(s)
- Michael Johnston
- Vanderbilt University Medical Center, 703 Oxford House, 1313 21st Avenue, South, Nashville, TN 37232-4700, USA.
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28
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Amoozgar H, Behniafard N, Borzoee M, Ajami GH. Correlation between peripheral and central venous pressures in children with congenital heart disease. Pediatr Cardiol 2008; 29:281-4. [PMID: 17851630 DOI: 10.1007/s00246-007-9067-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 08/13/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Abstract
Central venous pressure (CVP) measurement is a reliable method for evaluating intravascular volume status and cardiac function, but it is an invasive method that results in some complications such as arterial puncture, pneumothorax, and development of infection. The current study was performed to compare CVP measurements between central and peripheral catheters in infants and children with congenital heart disease referred for right-sided heart catheterization. The CVP and peripheral venous pressure (PVP) in 45 patients were measured simultaneously. The mean difference between CVPs measured from the central and peripheral catheters was 8 +/- 4 cm H(2)O. The linear regression equation showed that CVP = 0.32 PVP + 3.8 (r = 0.67; p < 0.005). There was no difference in CVP measurements depending on the intravenous cannula and chest diameters, arm diameter, arm length, body surface area, patient's age (< or =10 years and >10 years), and type of congenital heart disease (cyanotic or noncyanotic). In conclusion, although CVP measured from a peripheral intravenous catheter in infants and children with congenital heart disease is not as accurate as the measurement in adults, the aforementioned linear regression equation based on measurement of PVP gives a reliable estimate of CVP.
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Affiliation(s)
- H Amoozgar
- Division of Pediatric Cardiology, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, 71937-11351, Iran.
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Zuber M, Attenhofer Jost CH, Kipfer P, Collins SP, Michota F, Peacock WF. Acoustic cardiography augments prolonged QRS duration for detecting left ventricular dysfunction. Ann Noninvasive Electrocardiol 2008; 12:316-28. [PMID: 17970957 DOI: 10.1111/j.1542-474x.2007.00181.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prolonged QRS duration has been used as a marker for left ventricular (LV) systolic dysfunction (SD) and is used in the evaluation of patients presenting with known or suspected heart failure. The goal of this study was to compare the abilities of QRS duration and simultaneous digital ECG and heart sounds, that is acoustic cardiographic, parameters to identify patients with LV dysfunction. METHODS Our learning population consisted of 171 patients with possible chronic compensated or mildly decompensated heart failure who presented to an ambulatory cardiology clinic for echocardiographic examination. We defined LVSD as a LV ejection fraction < 50%, and estimated LV filling pressures from diastolic measurements. These patients also had acoustic cardiographic recordings from which we obtained a variety of individual ECG and acoustic cardiographic parameters. We used the product of four of these parameters to obtain a diagnostic score for LV dysfunction. We then compared the diagnostic performances of QRS duration and the score on a test population of patients who presented to an emergency department with possible heart failure. RESULTS In the learning population, the sensitivities/specificities of QRS duration > or =120 ms and the score for prediction of LVSD were 51%/92% and 77%/90%, respectively. In the test population, the score remained superior to QRS duration for detecting LVSD as well as acute decompensated heart failure. CONCLUSIONS Improved identification of LVSD and clinical heart failure can be achieved with a cost-effective bedside screening tool with the simple combination of simultaneously acquired digital ECG and heart sound data.
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Affiliation(s)
- Michel Zuber
- Cardiology Outpatient Clinic, Othmarsingen and Frauenfeld, Switzerland.
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Sinisalo J, Rapola J, Rossinen J, Kupari M. Simplifying the estimation of jugular venous pressure. Am J Cardiol 2007; 100:1779-81. [PMID: 18082526 DOI: 10.1016/j.amjcard.2007.07.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 07/04/2007] [Accepted: 07/04/2007] [Indexed: 11/28/2022]
Abstract
The classic technique of estimating jugular venous pressure, with variable inclination of the upper body and the sternal angle as the reference point, is complicated and little used in general practice. The aim of this prospective, comparative study was to assess whether estimating neck vein distension with the patient in the sitting position could be used to detecting elevated venous pressure. Patients (n = 96) who underwent right-sided cardiac catheterization or endomyocardial biopsy were evaluated. The visible height of the right internal jugular venous column above the clavicle was estimated, and the mean pressure in the right atrium or superior vena cava at cardiac catheterization was measured. Invasive venous pressure was elevated (>8 mm Hg) in 23 patients. A deep venous column visibly distended above the right clavicle in the sitting position had sensitivity of 65% and specificity of 85% to identify truly elevated venous pressure. Abdominal compression increased sensitivity to 77% but decreased specificity to 68%. In conclusion, studying the deep neck veins of a sitting patient simplifies the estimation of jugular venous pressure and has moderate to high diagnostic performance in detecting elevated central venous pressure.
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Affiliation(s)
- Juha Sinisalo
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Shah SJ, Michaels AD. Hemodynamic Correlates of the Third Heart Sound and Systolic Time Intervals. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1527-5299.2006.05773.x-i1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sanjiv J. Shah
- From the Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA;1 and the Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT2
| | - Andrew D. Michaels
- From the Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA;1 and the Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT2
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Clinical diagnosis of left ventricular dilatation and dysfunction in the age of technology. Eur J Heart Fail 2007; 9:723-9. [PMID: 17347039 DOI: 10.1016/j.ejheart.2007.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 12/27/2006] [Accepted: 02/06/2007] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The diagnostic process has become increasingly dependent on instrumental and laboratory investigation. AIM To evaluate the accuracy of symptoms and signs in identifying left ventricular (LV) dilatation and/or systolic dysfunction. METHODS A group of 100 patients in stable clinical condition and scheduled for cardiac magnetic resonance imaging was prospectively examined by two cardiologists, who were unaware of the individual patient's condition. Patients were interviewed and underwent physical examination. RESULTS Several symptoms and signs were associated with LV dilatation and systolic dysfunction at univariate analysis. Using multiple logistic regression, a mitral systolic murmur, a laterally displaced LV impulse, orthopnoea and hepatomegaly were all independent predictors of LV dilatation (end-diastolic volume >or=110 ml/m(2)) (p<0.0001) and LV dysfunction (ejection fraction <45%) (p<0.0001). The combination of the above variables correctly identified 79% of patients with LV dilatation (sensitivity 51%, specificity 92%), and 82% of patients with LV dysfunction (sensitivity 68%, specificity 90%). Considering LV dilatation and dysfunction, 77% of patients were correctly identified after history alone (kappa=0.13), 84% after LV impulse examination (kappa=0.55) and 86% after cardiac auscultation (kappa=0.58). CONCLUSION Symptoms and signs predict LV dilatation and/or dysfunction with fair sensitivity and excellent specificity.
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Abstract
The major components of the physical examination of patients with heart failure are presented to allow practical application by physicians and nurses working in this arena. Part II contains the key elements of the chest, precordial-cardiac, hepatic, and peripheral examination in this specific clinical setting. Supplemental maneuvers are provided. Finally, the overall role and merits of the physical examination in managing the heart failure patient are discussed.
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Affiliation(s)
- Carl V Leier
- Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University College of Medicine and Public Health, Columbus, OH 43210, USA.
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Abstract
The major components and merits of the physical examination of patients with heart failure are presented. A staging of the physical examination practiced by most heart failure specialists is proposed based on the information needed at the time of the encounter. The challenges to our subspecialty regarding this diagnostic tool are the prevention of its extinction during an era of seemingly limitless comprehensive laboratory testing, the promotion of its widespread use, and, over the years, the subjection of its components to the rigors of blinded controlled studies. Part I addresses the staging of the physical examination in heart failure, general observation of the patient, vital signs, and assessment of arterial pulse and neck veins.
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Affiliation(s)
- Carl V Leier
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine and Public Health, Columbus, OH 43210, USA.
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Abstract
Chronic heart failure is a common problem in old age. Dyspnoea and fatigue are the most common symptoms and should alert the clinician to the likely diagnosis. When there is a clinical suspicion of heart failure, further assessment is required to confirm the aetiology. In older patients, heart failure with normal systolic function is frequently encountered. However, patients with left ventricular systolic dysfunction usually have a poorer prognosis, and most treatments have been evaluated in these patients. Useful investigations include the 12-lead electrocardiogram, chest radiology and echocardiography. A blood test for B-type natriuretic peptide is being increasingly used as a 'rule out' test for heart failure. There are several treatment options. Initially, patients should be treated with a diuretic and ACE inhibitor, provided there are no contraindications. beta-Blocker therapy is also first-line therapy once a patients' haemodynamic status has been stabilized. Additional treatments include spironolactone, angiotensin antagonists and digoxin. Patient factors and tolerability may limit the number of treatment options. Treatment regimes are most effective when delivered using a multidisciplinary approach.
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Affiliation(s)
- Neil D Gillespie
- Medicine (Ageing & Health), University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, United Kingdom.
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Abstract
Injury to the myocardium disrupts geometric integrity and results in changes to intracardiac pressure, wall stress and tension, and the pattern of blood flow through the heart. Significant disruption to pump function results in heart failure which is defined in terms of symptoms: breathlessness and fatigue, signs of salt and water retention, and neurohormonal activation. This syndrome most commonly occurs in the context of injury due to ischaemic heart disease and dilated cardiomyopathy but because patients with congenital heart disease (CHD) are born with sometimes gross distortions of cardiac anatomy they too are subject to the forces that drive heart failure. This paper explores the available data relating to the clinical and neurohormonal manifestations of heart failure in patients with congenital heart disease and describes how, by additionally exploring events at a cellular level, we may be able to arrive at a definition of heart failure relevant to this population.
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Affiliation(s)
- Aidan P Bolger
- National Heart and Lung Institute, Imperial College, London, UK.
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37
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Perloff JK. Importance of elevated jugular venous pressure and a third heart sound in asymptomatic left ventricular dysfunction. Am J Med 2003; 114:499-500. [PMID: 12727583 DOI: 10.1016/s0002-9343(03)00124-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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