1
|
Sekma A, Bel Haj Ali K, Jeddi C, Ben Brahim N, Bzeouich N, Gannoun I, Trabelssi I, Laouiti K, Grissa MH, Beltaief K, Zohra D, Asma Z, Lotfi B, Rym Y, Ben Soltane H, Zied M, Mariem K, Msolli MA, Riadh B, Bouida W, Boubaker H, Nouira S. Value of nitroglycerin test in the diagnosis of heart failure in emergency department patients with undifferentiated dyspnea. Clin Cardiol 2021; 44:932-937. [PMID: 34076282 PMCID: PMC8259157 DOI: 10.1002/clc.23615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023] Open
Abstract
Background Rapid diagnosis of heart failure (HF) in acutely dyspneic patients can be challenging for emergency department (ED) physicians. Hypothesis Cardiac output (CO) change with sublingual nitroglycerin (NTG) could be helpful in the diagnosis of HF in patients with acute undifferentiated dyspnea. Materials and Methods A prospective study of patients >18 years admitted to the ED for acute dyspnea. Using thoracic bioimpedance, we measured CO change at baseline and after sublingual administration of 0.6 mg of NTG. HF was defined on the basis of clinical examination, pro‐brain natriuretic peptide levels, and echocardiographic findings. Diagnostic performance of delta CO was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve. Results This study included 184 patients with mean age of 64 years. Baseline CO was comparable between the HF group and the non‐HF group. At its best cutoff (29%), delta CO showed good accuracy in the diagnosis of HF with a sensitivity, specificity, positive and negative likelihood ratios of 80%, 44%, 57%, and 66% respectively. Area under ROC curve was 0.701 [95% CI 0.636–0.760]. The decrease of CO with sublingual NTG was significantly higher in patients with HFpEF compared with those with HFrEF. Multivariate analysis, showed that delta CO was an independent factor associated with HF diagnosis [OR 0.19 (95% CI 0.11–0.29); p < .001]. Conclusions Our study showed that CO change with sublingual nitroglycerin is a simple tool that may be helpful for the diagnosis of HF in ED patients with undifferentiated dyspnea.
Collapse
Affiliation(s)
- Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Camilia Jeddi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Nadia Ben Brahim
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Nasri Bzeouich
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Imen Gannoun
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Imen Trabelssi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Kamel Laouiti
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Dridi Zohra
- Cardiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Zorgati Asma
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Boukadida Lotfi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Youssef Rym
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Houda Ben Soltane
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mezgar Zied
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Khrouf Mariem
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Boukef Riadh
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| |
Collapse
|