Abstract | BACKGROUND: The incremental role of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) over the clinical judgment has been recently reported in the emergency diagnosis of congestive heart failure with a normal left ventricular ejection fraction (HFNEF). However, how well does this diagnostic strategy be applicable in the setting of atrial fibrillation is unknown. OBJECTIVE: To investigate the usefulness of bedside tissue Doppler echocardiography and BNP in the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation. METHODS: Forty-one consecutive elderly patients with an ejection fraction > or =50% (mean age 84 years; 22 with HFNEF and 19 with noncardiac cause), hospitalized for acute dyspnea at rest, were prospectively enrolled; bedside septal E/Ea and BNP were obtained at admission. RESULTS: By multivariable logistic regression analysis including the clinical judgment of heart failure, E/Ea and BNP, E/Ea (P = 0.014) and BNP (P = 0.018) provided independent diagnostic information. Optimal cutoffs were 13 for E/Ea (area under the ROC curve of 0.846, P < 0.0001; sensitivity 81.8%, specificity 89.5%) and 253 pg/ml for BNP (area under the ROC curve of 0.928, P < 0.0001; sensitivity 86.4%, specificity 89.5%). The concordance between the clinical judgment and BNP concentration at the cutoff of 253 pg/ml correctly classified 24 of 25 patients; E/Ea at the cutoff of 13 correctly classified 14 of the 16 patients with discrepancy. CONCLUSION: Bedside tissue Doppler echocardiography and BNP provide useful additional diagnostic information over the clinical judgment for the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation.
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Authors | Stephane Arques, Emmanuel Roux, Pascal Sbragia, Bertrand Pieri, Richard Gelisse, Roger Luccioni, Pierre Ambrosi |
Journal | Echocardiography (Mount Kisco, N.Y.)
(Echocardiography)
Vol. 24
Issue 5
Pg. 499-507
(May 2007)
ISSN: 0742-2822 [Print] United States |
PMID | 17456069
(Publication Type: Journal Article)
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Chemical References |
- Biomarkers
- Natriuretic Peptide, Brain
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Topics |
- Acute Disease
- Aged
- Aged, 80 and over
- Analysis of Variance
- Area Under Curve
- Atrial Fibrillation
(blood, diagnostic imaging, physiopathology)
- Biomarkers
(blood)
- Confounding Factors, Epidemiologic
- Diagnosis, Differential
- Dyspnea
(blood, diagnostic imaging, epidemiology, etiology, physiopathology)
- Echocardiography, Doppler
- Female
- Heart Failure
(blood, complications, diagnostic imaging, epidemiology, physiopathology)
- Humans
- Logistic Models
- Male
- Natriuretic Peptide, Brain
(blood)
- Point-of-Care Systems
- Prospective Studies
- Research Design
- Sensitivity and Specificity
- Stroke Volume
- Ventricular Function, Left
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