title: Noninvasive assessment of acute dyspnea in the ED.
abstract: BACKGROUND
  We compared the ability of noninvasive measurements of cardiac output (CO) and thoracic fluid content (TFC) and their change in response to orthostatic challenges to diagnose acute decompensate heart failure (ADHF) from non-ADHF causes of acute dyspnea in patients in the ED.
  
  
  METHODS
  Forty-five patients &gt; 44 years old presenting in the ED with dyspnea were studied. CO and TFC were monitored with a NICOM bioreactance device. CO and TFC were measured continuously while each patient was sitting, supine, and during a passive leg-raising maneuver (3 min each); the maximal values during each maneuver were reported. Orthostatic challenges were repeated 2 h into treatment. One patient was excluded because of intolerance to the supine position. Diagnoses obtained with the hemodynamic measurements were compared with ED diagnoses and with two expert physicians by chart review (used as gold standard diagnosis); both groups were blinded to CO and TFC values. Patient's treatment, ED disposition, hospital length of stay, and subjective dyspnea (Borg scale) were also recorded.
  
  
  RESULTS
  Sixteen of 44 patients received a diagnosis of ADHF and 28 received a diagnosis of non-ADHF by the experts. Baseline TFC was higher in patients with ADHF (P = .001). Fifteen patients were treated for ADHF, and their Borg scale values decreased at 2 h (P &lt; .05). TFC threshold of 78.8 had a receiver operator characteristic area under the curve of 0.81 (76% sensitivity, 71% specificity) for ADHF. Both ADHF and non-ADHF groups were similar in their increased CO from baseline to PLR and supine. Pre- and posttreatment measurements were similar.
  
  
  CONCLUSIONS
  Baseline TFC can discriminate patients with ADHF from non-ADHF dyspnea in the ED.
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Intensive Care Medicine, Hospital of Sabadell, CIBER Enfermedades Respiratorias, Institut Universitari Parc Taulí-Autonomous, University of Barcelona, Sabadell, Spain.
authors.forename: Xaime
authors.initials: X
authors.lastname: García
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Peter
authors.initials: P
authors.lastname: Simon
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.affiliation: Department of Cardiovascular Diseases, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Ramani
authors.affiliation: Department of Cardiovascular Diseases, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Rene
authors.initials: R
authors.lastname: Alvarez
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Quintero
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: pinskymr@upmc.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pinsky
mesh_terms: D000208:Acute Disease; D000328:Adult; D001826:Body Fluids / Q000378:metabolism; D002302:Cardiac Output; D004417:Dyspnea / Q000175:diagnosis* / Q000503:physiopathology; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011187:Posture / Q000502:physiology; D012680:Sensitivity and Specificity
chemical_list: D020097:Natriuretic Peptide, Brain