Abstract
Background: Dyspnea is a common symptom and can be caused by many different conditions. The detection of congestive heart failure (CHF) is sometimes difficult.
Hypothesis: The pulse amplitude ratio (PAR) measured by the Finapress procedure during a Valsalva maneuver can detect elevated left ventricular end‐diastolic pressure (LVEDP) accurately over a wide range of values.
Methods: Comparison of the estimated LVEDP by PAR with the invasively measured LVEDP before and after ventriculography during coronography was made in 101 consecutive stable patients referred for chest pain and/or chronic dyspnea.
Results: A significant correlation was found between the catheter‐measured LVEDP (range 3‐40 mmHg) and the PAR (R2 = 0.70, p< 0.001). The receiver operator characteristics (ROC) of the PAR to detect an LVEDP > 15 mmHg can be considered to be excellent, with an area under the ROC curve achieving 0.92 (95% confidence interval [CI] 0.87‐0.96; p< 0.001). APAR of>0.675 predicted the presence of an LVEDP > 15 mmHg with a sensitivity of 0.865 (95% CI 0.780‐0.926) and a specificity of 0.847 (95% CI 0.730‐0.928). The positive and negative LRs were 5.70 and 0.16, respectively.
Conclusions: The observed likelihood ratios confirm that the PAR determined by the Finapress procedure may be a useful bedside diagnostic tool in patients with cardiac conditions.
Keywords: congestive heart failure, pulse amplitude ratio, Valsalva maneuver, left ventricular end‐diastolic pressure
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