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

Abstract Background: Heart failure (HF) 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 HF in patients admitted to the emergency department (ED) for AECOPD.Methods: This is a prospective observational study including patients presenting to the ED with AECOPD. Each included patient received NIV with inspiratory pressure support (PS) set at 5 and 30 cmH2O for 15 min in random order. We measured plethesmographic pulse pressure (PP) at PS of 5cmH2O (PP5) and 30 cmH2O (PP30). We calculated the PAR under NIV (PARNIV) as the PP30 /PP5 ratio. Patients were divided into two groups: a group identified as having HF (HF group) and a group without HF (non HF group). The diagnostic performance of PARNIV was assessed by standard methods.Results: 73 patients were included in this study: 32 in HF group and 41 in non HF- group. The two groups had comparable demographic and clinical characteristics at admission. The mean values of PARNIV was significantly higher among HF patients (0.86 versus 0.71; p<0 .01). The area under the receiver operating characteristic curve of PARNIV was 0.75. Using the best cut-off (0.6), the sensitivity of PARNIV was 93% with a specificity 21%, a positive predictive value of 48%, and a negative predictive value of 81%. Correlation between PARNIV and BNP was significant (r =0.52; p=0.002)Conclusion: Measurement of PARNIV in patients presenting to the ED with AECOPD had a good diagnostic performance for the detection of HF and could represent an interesting alternative for the currently available methods.The study was registered in the Clinical Trial Registration System (clinicaltrials.gov) under the study number NCT05189119.