BackgroundPhysical examination and B-type natriuretic peptide (BNP) have been used to
estimate hemodynamics and tailor therapy of acute decompensated heart
failure (ADHF) patients. However, correlation between these parameters and
left ventricular filling pressures is controversial.ObjectiveThis study was designed to evaluate the diagnostic accuracy of physical
examination, chest radiography (CR) and BNP in estimating left atrial
pressure (LAP) as assessed by tissue Doppler echocardiogram.MethodsPatients admitted with ADHF were prospectively assessed. Diagnostic
characteristics of physical signs of heart failure, CR and BNP in predicting
elevation (> 15 mm Hg) of LAP, alone or combined, were calculated.
Spearman test was used to analyze the correlation between non-normal
distribution variables. The level of significance was 5%.ResultsForty-three patients were included, with mean age of 69.9 ± 11.1years,
left ventricular ejection fraction of 25 ± 8.0%, and BNP of 1057
± 1024.21 pg/mL. Individually, all clinical, CR or BNP parameters had
a poor performance in predicting LAP ≥ 15 mm Hg. A clinical score of
congestion had the poorest performance [area under the receiver operating
characteristic curve (AUC) 0.53], followed by clinical score + CR (AUC
0.60), clinical score + CR + BNP > 400 pg/mL (AUC 0.62), and clinical
score + CR + BNP > 1000 pg/mL (AUC 0.66).ConclusionPhysical examination, CR and BNP had a poor performance in predicting a LAP
≥ 15 mm Hg. Using these parameters alone or in combination may lead
to inaccurate estimation of hemodynamics.