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      Respiratory sound energy and its distribution patterns following clinical improvement of congestive heart failure: a pilot study

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          Abstract

          Background

          Although congestive heart failure (CHF) patients typically present with abnormal auscultatory findings on lung examination, respiratory sounds are not normally subjected to additional analysis. The aim of this pilot study was to examine respiratory sound patterns of CHF patients using acoustic-based imaging technology. Lung vibration energy was examined during acute exacerbation and after clinical improvement.

          Methods

          Respiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique. Twenty-three consecutive CHF patients were imaged at the time of presentation to the emergency department and after clinical improvement. Digital images were created (a larger image represents more homogeneously distributed vibration energy of respiratory sound). Geographical area of the images and respiratory sound patterns were quantitatively analyzed. Data from the CHF patients were also compared to healthy volunteers.

          Results

          The median (interquartile range) geographical areas of the vibration energy image of acute CHF patients without and with radiographically evident pulmonary edema were 66.9 (9.0) and 64.1(9.0) kilo-pixels, respectively ( p < 0.05). After clinical improvement, the geographical area of the vibration energy image of CHF patients without and with radiographically evident pulmonary edema were increased by 18 ± 15% ( p < 0.05) and 25 ± 16% ( p < 0.05), respectively.

          Conclusions

          With clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image.

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          Most cited references27

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          Respiratory sounds. Advances beyond the stethoscope.

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            Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance.

            In congestive heart failure (CHF), the prognostic significance of impaired respiratory muscle strength has not been established. Maximal inspiratory pressure (Pi(max)) was prospectively determined in 244 consecutive patients (207 men) with CHF (ischemic, n=75; idiopathic dilated cardiomyopathy, n=169; age, 54+/-11 years; left ventricular ejection fraction [LVEF], 22+/-10%). Pi(max) was lower in the 244 patients with CHF than in 25 control subjects (7.6+/-3.3 versus 10.5+/-3.7 kPa; P=0.001). The 57 patients (23%) who died during follow-up (23+/-16 months; range, 1 to 48 months) had an even more reduced Pi(max) (6.3+/-3.2 versus 8.1+/-3.2 kPa in survivors; P=0.001). Kaplan-Meier survival curves differentiated between patients subdivided according to quartiles for Pi(max) (P=0.014). Pi(max) was a strong risk predictor in both univariate (P=0.001) and multivariate Cox proportional hazard analyses (P=0.03); multivariate analyses also included NYHA functional class, LVEF, peak oxygen consumption (peak VO(2)), and norepinephrine plasma concentration. The areas under the receiver-operating characteristic curves for prediction of 1-year survival were comparable for Pi(max) and peak VO(2) (area under the curve [AUC], 0.68 versus 0.73; P=0.28), and they improved with the triple combination of Pi(max), peak VO(2), and LVEF (AUC, 0.82; P=0.004 compared with AUC of Pi(max)). In patients with CHF, inspiratory muscle strength is reduced and emerges as a novel, independent predictor of prognosis. Because testing for Pi(max) is simple in clinical practice, it might serve as an additional factor to improve risk stratification and patient selection for cardiac transplantation.
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              The pulmonary manifestations of left heart failure.

              Determining whether a patient's symptoms are the result of heart or lung disease requires an understanding of the influence of pulmonary venous hypertension on lung function. Herein, we describe the effects of acute and chronic elevations of pulmonary venous pressure on the mechanical and gas-exchanging properties of the lung. The mechanisms responsible for various symptoms of congestive heart failure are described, and the significance of sleep-disordered breathing in patients with heart disease is considered. While the initial clinical evaluation of patients with dyspnea is imprecise, measurement of B-type natriuretic peptide levels may prove useful in this setting.
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                Author and article information

                Journal
                BMC Emerg Med
                BMC Emergency Medicine
                BioMed Central
                1471-227X
                2010
                15 January 2010
                : 10
                : 1
                Affiliations
                [1 ]Division of Critical Care Medicine, Robert Wood Johnson School of Medicine - University of Medicine and Dentistry of New Jersey - Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USA
                [2 ]Department of Emergency Medicine, Robert Wood Johnson School of Medicine - University of Medicine and Dentistry of New Jersey - Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USA
                [3 ]Department of Emergency Medicine, Beijing Shi-ji-tan Hospital, 10 Tie Yi Rd., Haidian District Beijing 100038, PR China
                Article
                1471-227X-10-1
                10.1186/1471-227X-10-1
                2821310
                20078862
                b92bf438-f4c0-4639-946e-09b8d64a6a84
                Copyright ©2010 Wang et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 February 2009
                : 15 January 2010
                Categories
                Research article

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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