The Role Of Non-invasive Hemodynamic Indicators In Differential Diagnosis Of Cardiogenic And Pulmonary Dyspnea

Objective:Cardiogenic dyspnea and pulmonary dyspnea often have difficulty in identification during clinical emergency treatment,and their inappropriate treatment will affect the prognosis of patients.Non-invasive Cardiac Output Monitor(NICOM)can detect whether the patient has heart failure by detecting changes in hemodynamic parameters.This study intends to analyze the hemodynamic parameters of dyspnea patients measured by a noninvasive cardiac output monitor through prospective observation,and explore its role in quickly differentiating cardiogenic dyspnea and pulmonary dyspnea,and provide clinical reference for the treatment of such patients.Methods:In this study,a prospective single center and parallel control method was used.The clinical data of patients with dyspnea treated in resuscitation room,emergency medical department of the Affiliated Hospital of North Sichuan Medical College were collected:name,gender,age,weight,past history,basic diseases,etc.After the patient's consultation,NICOM measurement was immediately obtained in the emergency room,as well as the examination of N-terminal pro-B-type natriuretic peptide(NT-proBNP),electrocardiogram,blood gas analysis,blood routine,biochemical coagulation routine,markers of myocardial injury and image inspection were performed.The emergency department physician blinded to the results of the non-invasive cardiac output test divided the enrolled dyspnea patients into cardiogenic dyspnea group and the pulmonary dyspnea group based on the patient's clinical symptoms,NT-proBNP detected on the day of admission,cardiac color Doppler ultrasound,chest radiographs,and treatment results.The outcomes of NICOM measurement of the two groups were analyzed and compared to judge their diagnostic value.The data was statistically processed using SPSS23.0 statistical software.Spearman correlation analysis was performed on the indicators of statistical differences.Using ROC curve analysis of indicators to predict cardiogenic dyspnea,and the sensitivity and specificity were analyzed and compared.Results:66 patients with dyspnea collected from September 2019 to January 2020 in the Department of Emergency Medicine,Affiliated Hospital of North Sichuan Medical College were divided into cardiogenic dyspnea group(n=35)and the pulmonary dyspnea group(n=31).(1)There was no statistical difference between the two groups in age,gender,height,weight,respiration,body temperature,systolic blood pressure,and diastolic blood pressure(P>0.05);heart rate and NT-proBNP were statistically different(P<0.05).The heart rate in the cardiogenic dyspnea group was faster and the level of NT-proBNP was higher;(2)Comparing the two groups of hemodynamic parameters measured by NICOM,the body surface area(BSA)of the two groups was not statistically significant(P>0.05),CO,CI,SV,and SVI in the cardiogenic dyspnea group were lower than those in the pulmonary dyspnea group(P<0.05);TFC and TPRI were higher in the cardiogenic dyspnea group(P<0.001);(3)the level of NT-proBNP has a weak correlation with CO,CI,SV,SVI(r<0.4),while has significant correlation with TFC and TPRI(r>0.6);(4)Area under curve(AUC)of NT-proBNP,TPRI,and TFC were 0.81(95%CI:0.72?0.92),0.80(95%CI:0.70?0.90),0.75(95%CI:0.63?0.87),P<0.05,respectively.When the cut-off of TFC and TPRI are 56.1(K?)and 2384(dynes·sec/cm5/m2),the sensitivity of them are 0.69,0.74,the specificityare0.84,0.79,and the Youden Indexare 0.52,0.55,respectively.The sensitivity and specificity of TFC and TPRI are lower than that of NT-proBNP,while the sensitivity of TFC combined TPRI was 0.75,and specificity was 0.90,both of them are higher than that of NT-proBNP.Conclusions:1.There is no significant correlation between CO,CI,SV,SVI monitored by NICOM and NT-proBNP in patients with dyspnea,suggesting that these parameters may not provide accurate results as a differential diagnosis indicator.2.TFC and TPRI monitored by NICOM are significantly correlated with NT-proBNP.When used as an indicator to diagnosis cardiogenic and pulmonary dyspnea,the sensitivity and specificity of it are not ideal.3.Detection with the combination of TFC and TPRI monitored by NICOM can enhance the sensitivity and specificity,which can help clinicians to quickly differentiate the cardiogenic dyspnea and pulmonary dyspnea.