title: Bedside prediction of increased filling pressure using acoustic electrocardiography.
abstract: BACKGROUND
  Patients presenting with acute dyspnea are often a diagnostic dilemma. A bedside tool that accurately and rapidly identifies increased left ventricular (LV) filling pressure would be helpful. We evaluated acoustic electrocardiography for this purpose.
  
  
  METHODS
  We pooled 3 cohorts of patients for this analysis. Inclusion criteria required acoustic electrocardiography and echocardiography within 4 hours of each other. Increased LV filling pressure was defined as a pseudonormal or restrictive filling pattern on echocardiography. Area under the receiver operating characteristic curve (AUC) assessed multivariable model accuracy.
  
  
  RESULTS
  The median age of the 324 patients was 61 years (range, 19-90 years), 67% were male, and 82% had a history of heart failure. The final multivariable model included mean LV systolic time, S(3) score, maximum negative area of the P wave, and the QTc interval. The AUC was 0.83 (95% confidence interval, 0.78-0.88). Although B-type natriuretic peptide (BNP) was an independent predictor of estimated increased filling pressure when considered alone (odds ratio = 1.002, 95% confidence interval, 1.000-1.003, P = .002), when added to the acoustic model, it did not improve overall model accuracy. In the subset of patients with indeterminate BNP levels (100-500 pg/mL), the acoustic model was more accurate than BNP (AUC = 0.82 vs 0.71).
  
  
  CONCLUSIONS
  Bedside acoustic electrocardiography predicted echocardiographic correlates of increased pressures with high accuracy. For patients with an indeterminate BNP level (100-500 pg/mL), the acoustic electrocardiography model was superior to BNP. Prospective model validation is warranted.
authors: University of Cincinnati, Cincinnati, OH, USA. collinsp@ucmail.uc.edu
authors: Sean P
authors: SP
authors: Collins
authors: Christopher J
authors: CJ
authors: Lindsell
authors: Michael C
authors: MC
authors: Kontos
authors: Michel
authors: M
authors: Zuber
authors: Peter
authors: P
authors: Kipfer
authors: Christine
authors: C
authors: Attenhofer Jost
authors: Douglas
authors: D
authors: Kosmicki
authors: Andrew D
authors: AD
authors: Michaels
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004417:Dyspnea / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left
chemical_list: D020097:Natriuretic Peptide, Brain