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. 2021 Jul;44(7):932-937.
doi: 10.1002/clc.23615. Epub 2021 Jun 2.

Value of nitroglycerin test in the diagnosis of heart failure in emergency department patients with undifferentiated dyspnea

Adel Sekma  1   2 , Khaoula Bel Haj Ali  1   2 , Camilia Jeddi  1   2 , Nadia Ben Brahim  1   2 , Nasri Bzeouich  1   2 , Imen Gannoun  2 , Imen Trabelssi  2 , Kamel Laouiti  1   2 , Mohamed Habib Grissa  1   2 , Kaouthar Beltaief  1   2 , Dridi Zohra  3 , Zorgati Asma  2   4 , Boukadida Lotfi  2   4 , Youssef Rym  2   4 , Houda Ben Soltane  5 , Mezgar Zied  5 , Khrouf Mariem  5 , Mohamed Amine Msolli  1   2 , Boukef Riadh  2   4 , Wahid Bouida  1   2 , Hamdi Boubaker  1   2 , Semir Nouira  1   2
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Value of nitroglycerin test in the diagnosis of heart failure in emergency department patients with undifferentiated dyspnea

Adel Sekma et al. Clin Cardiol. 2021 Jul.

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.

Keywords: diagnosis; dyspnea; heart failure; nitroglycerin.

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Conflict of interest statement

The authors declare no potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Comparison of cardiac output change in heart failure and non‐heart failure patients between baseline and after nitroglycerin test
FIGURE 2
FIGURE 2
Receiver operating characteristic curve of delta cardiac output (cardiac output difference at baseline and after nitroglycerin test) for the diagnosis of heart failure
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