Abstract
Heart failure (HF) is the one cardiovascular disease that is increasing in prevalence in the United States. As the population continues to age, the incidence will certainly be amplified. However, some studies have shown that HF is correctly diagnosed initially in only 50% of affected patients. Despite the use of history, physical examination, echocardiogram, and chest x-ray, the percentage of correct initial diagnosis of HF is low. Recognizing the symptoms of HF decompensations is often problematic because other diagnoses can mimic them. There are two new diagnostic modalities that offer promise in improving HF diagnostic accuracy and identifying early HF decompensations. These diagnostic modalities include tests utilizing impedance cardiography and the B-type natriuretic peptide assay. They have the potential of increasing the accuracy of HF diagnosis and guide pharmacological treatment in the inpatient and outpatient settings. They may also assist in the recognition (or prediction) of acute HF decompensations.
Full text
PDFImages in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Dao Q., Krishnaswamy P., Kazanegra R., Harrison A., Amirnovin R., Lenert L., Clopton P., Alberto J., Hlavin P., Maisel A. S. Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol. 2001 Feb;37(2):379–385. doi: 10.1016/s0735-1097(00)01156-6. [DOI] [PubMed] [Google Scholar]
- Dao Q., Krishnaswamy P., Kazanegra R., Harrison A., Amirnovin R., Lenert L., Clopton P., Alberto J., Hlavin P., Maisel A. S. Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol. 2001 Feb;37(2):379–385. doi: 10.1016/s0735-1097(00)01156-6. [DOI] [PubMed] [Google Scholar]
- Davis M., Espiner E., Richards G., Billings J., Town I., Neill A., Drennan C., Richards M., Turner J., Yandle T. Plasma brain natriuretic peptide in assessment of acute dyspnoea. Lancet. 1994 Feb 19;343(8895):440–444. doi: 10.1016/s0140-6736(94)92690-5. [DOI] [PubMed] [Google Scholar]
- Drazner Mark H., Thompson Brenda, Rosenberg Paul B., Kaiser Patricia A., Boehrer James D., Baldwin Brian J., Dries Daniel L., Yancy Clyde W. Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy. Am J Cardiol. 2002 Apr 15;89(8):993–995. doi: 10.1016/s0002-9149(02)02257-9. [DOI] [PubMed] [Google Scholar]
- Dries D. L., Exner D. V., Gersh B. J., Cooper H. A., Carson P. E., Domanski M. J. Racial differences in the outcome of left ventricular dysfunction. N Engl J Med. 1999 Feb 25;340(8):609–616. doi: 10.1056/NEJM199902253400804. [DOI] [PubMed] [Google Scholar]
- Hendrickson K. Cost-effectiveness of noninvasive hemodynamic monitoring. AACN Clin Issues. 1999 Aug;10(3):419–424. doi: 10.1097/00044067-199908000-00012. [DOI] [PubMed] [Google Scholar]
- Kazanegra R., Cheng V., Garcia A., Krishnaswamy P., Gardetto N., Clopton P., Maisel A. A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Card Fail. 2001 Mar;7(1):21–29. doi: 10.1054/jcaf.2001.23355. [DOI] [PubMed] [Google Scholar]
- Kupari M., Lindroos M., Iivanainen A. M., Heikkilä J., Tilvis R. Congestive heart failure in old age: prevalence, mechanisms and 4-year prognosis in the Helsinki Ageing Study. J Intern Med. 1997 May;241(5):387–394. doi: 10.1046/j.1365-2796.1997.129150000.x. [DOI] [PubMed] [Google Scholar]
- Maisel A. S., Koon J., Krishnaswamy P., Kazenegra R., Clopton P., Gardetto N., Morrisey R., Garcia A., Chiu A., De Maria A. Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am Heart J. 2001 Mar;141(3):367–374. doi: 10.1067/mhj.2001.113215. [DOI] [PubMed] [Google Scholar]
- Morrison L. Katherine, Harrison Alex, Krishnaswamy Padma, Kazanegra Radmila, Clopton Paul, Maisel Alan. Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol. 2002 Jan 16;39(2):202–209. doi: 10.1016/s0735-1097(01)01744-2. [DOI] [PubMed] [Google Scholar]
- Sageman W. Scott, Riffenburgh Robert H., Spiess Bruce D. Equivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery. J Cardiothorac Vasc Anesth. 2002 Feb;16(1):8–14. doi: 10.1053/jcan.2002.29635. [DOI] [PubMed] [Google Scholar]
- Shah M. R., O'Connor C. M., Sopko G., Hasselblad V., Califf R. M., Stevenson L. W. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE): design and rationale. Am Heart J. 2001 Apr;141(4):528–535. doi: 10.1067/mhj.2001.113995. [DOI] [PubMed] [Google Scholar]
- Silver Marc A., Cianci Pamela, Brennan Sharon, Longeran-Thomas Helen, Ahmad Faheem. Evaluation of impedance cardiography as an alternative to pulmonary artery catheterization in critically ill patients. Congest Heart Fail. 2004 Mar-Apr;10(2 Suppl 2):17–21. doi: 10.1111/j.1527-5299.2004.03410.x. [DOI] [PubMed] [Google Scholar]
- Tsutamoto T., Wada A., Maeda K., Hisanaga T., Maeda Y., Fukai D., Ohnishi M., Sugimoto Y., Kinoshita M. Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation. 1997 Jul 15;96(2):509–516. doi: 10.1161/01.cir.96.2.509. [DOI] [PubMed] [Google Scholar]
- Van De Water Joseph M., Miller Timothy W., Vogel Robert L., Mount Bruce E., Dalton Martin L. Impedance cardiography: the next vital sign technology? Chest. 2003 Jun;123(6):2028–2033. doi: 10.1378/chest.123.6.2028. [DOI] [PubMed] [Google Scholar]
- Wheeldon N. M., MacDonald T. M., Flucker C. J., McKendrick A. D., McDevitt D. G., Struthers A. D. Echocardiography in chronic heart failure in the community. Q J Med. 1993 Jan;86(1):17–23. [PubMed] [Google Scholar]
- Yancy Clyde, Abraham William T. Noninvasive hemodynamic monitoring in heart failure: utilization of impedance cardiography. Congest Heart Fail. 2003 Sep-Oct;9(5):241–250. doi: 10.1111/j.1751-7133.2003.tb00021.x. [DOI] [PubMed] [Google Scholar]