Pulse amplitude ratio under noninvasive ventilation as a new method in the diagnosis of left heart failure in patients with acute exacerbation of chronic obstructive pulmonary disease

Khaoula Bel Haj Ali; Adel Sekma; Ikram Chamtouri; Kaouthar Beltaief; Mohamed Amine Msolli; Zied Mezgar; Wahid Bouida; Riadh Boukef; Hamdi Boubaker; Mohamed Habib Grissa; Semir Nouira

doi:10.1186/s12872-023-03089-y

Pulse amplitude ratio under noninvasive ventilation as a new method in the diagnosis of left heart failure in patients with acute exacerbation of chronic obstructive pulmonary disease

BMC Cardiovasc Disord. 2023 Feb 24;23(1):105. doi: 10.1186/s12872-023-03089-y.

Authors

Khaoula Bel Haj Ali^{1

2}, Adel Sekma^{1

2}, Ikram Chamtouri³, Kaouthar Beltaief^{1

2}, Mohamed Amine Msolli^{1

2}, Zied Mezgar⁴, Wahid Bouida^{1

2}, Riadh Boukef^{2

5}, Hamdi Boubaker^{1

2}, Mohamed Habib Grissa^{1

2}, Semir Nouira^{6

7}

Affiliations

¹ Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.
² Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.
³ Cardiology Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.
⁴ Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia.
⁵ Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.
⁶ Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia. semir.nouira.urg@gmail.com.
⁷ Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia. semir.nouira.urg@gmail.com.

Abstract

Background: Left heart failure (LHF) is commonly associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) but its role is often underestimated.

Aim of study: To evaluate the performance of a new diagnostic technique based on the measurement of the pulse amplitude ratio (PAR) using non-invasive ventilation (NIV) for the early identification LHF in patients admitted to the emergency department (ED) for AECOPD.

Results: 73 patients were included in this study: 32 in LHF group and 41 in non LHF- group. The two groups had comparable demographic and clinical characteristics at admission. The mean values of PAR_NIV was significantly higher among LHF patients (0.86 vs. 0.71; p < 0.01). The area under the receiver operating characteristic curve of PAR_NIV was 0.75. Using the best cut-off (0.6), the sensitivity of PAR_NIV was 93% with a specificity 21%, a positive predictive value of 48%, and a negative predictive value of 81%. Correlation between PAR_NIV and BNP was significant (r = 0.52; p = 0.002).

Conclusion: Measurement of PAR_NIV in patients presenting to the ED with AECOPD had a good diagnostic performance for the detection of LHF and could represent an interesting alternative for the currently available methods. Trial registration The study was registered in the Clinical Trial Registration System (clinicaltrials.gov) under the study number NCT05189119, https://register.

Clinicaltrials: gov/prs/app/action/SelectProtocol?sid=S000BOO4&selectaction=Edit&uid=U0000QAM&ts=2&cx=qrmluh .

Keywords: Chronic obstructive pulmonary disease; Heart failure; Non-invasive ventilation; Pulse amplitude ratio.

MeSH terms

Heart Failure*
Humans
Noninvasive Ventilation* / methods
Predictive Value of Tests
Pulmonary Disease, Chronic Obstructive* / diagnosis
Respiration, Artificial

Associated data

ClinicalTrials.gov/NCT05189119