Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver.

Autor: Galiatsatos P; Critical Care Department, National Institutes of Health, Bethesda, Maryland., Win TT; Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico., Monti J; Division of Cardiology, Maine Medical Center, Portland, Maine., Johnston PV; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Herzog W; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Trost JC; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Hwang CW; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Fridman GY; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland., Wang NY; 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., Silber HA; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: hsilber@jhmi.edu.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2017 Apr 01; Vol. 119 (7), pp. 1053-1060. Date of Electronic Publication: 2017 Jan 05.
DOI: 10.1016/j.amjcard.2016.11.063
Abstrakt: 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.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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