title: Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver.
abstract: The high rate of re-hospitalization for heart failure might be reduced by improving noninvasive techniques for identifying elevated left ventricular (LV) filling pressure. We previously showed that changes in a finger photoplethysmography (PPG) waveform during the Valsalva maneuver (VM) reflect invasively measured LV end-diastolic pressure (LVEDP). We have since developed a hand-held device that analyzes PPG while guiding the expiratory effort of a VM. Here we assessed the sensitivity and specificity of this device for identifying elevated LVEDP in patients. We tested 82 participants (28 women), aged 40 to 85 years, before a clinically indicated left heart catheterization. Each performed a VM between 18 and 25 mm Hg for 10 seconds into a pressure transducer. PPG was recorded continuously before and during the VM. LVEDP was measured during the catheterization. An equation for calculating LVEDP was derived using (1) ratio of signal amplitudes: minimum during VM to average at baseline, (2) ratio of peak-to-peak time intervals: minimum during VM to average at baseline, and (3) mean blood pressure. Calculated and measured LVEDP were compared. The range of measured LVEDP was 4 to 35 mm Hg. Calculated LVEDP correlated with measured LVEDP (p <0.0001, r = 0.56). A calculated LVEDP >20 mm Hg had a 70% sensitivity and 86% specificity for identifying measured LVEDP >20 mm Hg (area under receiver-operating characteristic curve 0.83). In conclusion, a hand-held device for assessing LV filling pressure had high specificity and good sensitivity for identifying LVEDP >20 mm Hg, a clinically meaningful threshold in heart failure.
authors.affiliation: Critical Care Department, National Institutes of Health, Bethesda, Maryland.
authors.forename: Panagis
authors.initials: P
authors.lastname: Galiatsatos
authors.affiliation: Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Theingi Tiffany
authors.initials: TT
authors.lastname: Win
authors.affiliation: Division of Cardiology, Maine Medical Center, Portland, Maine.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Monti
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Johnston
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: William
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Trost
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Chao-Wei
authors.initials: CW
authors.lastname: Hwang
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Gene Y
authors.initials: GY
authors.lastname: Fridman
authors.affiliation: Departments of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biostatistics and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: hsilber@jhmi.edu.
authors.forename: Harry A
authors.initials: HA
authors.lastname: Silber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D006328:Cardiac Catheterization; D004867:Equipment Design; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography / Q000295:instrumentation*; D012680:Sensitivity and Specificity; D014160:Transducers, Pressure; D014636:Valsalva Maneuver / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*