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Dyspnea Differentiation Index^*

A New Method for the Rapid Separation of Cardiac vs Pulmonary Dyspnea

^* From the Department of Medicine (Drs. Ravakhah, Tun, Epstein, and West), Meridia Huron Hospital, Cleveland, OH; and the Department of Biostatistics (Mr. Jacobsen) and Division of Pulmonary and Critical Care Medicine (Drs. Ailani and DiGiovine), Henry Ford Hospital, Detroit, MI.

Study objective: To assess the utility of a new parameter in the differentiation of dyspnea of cardiac origin from dyspnea of pulmonary origin.

Methods: The peak expiratory flow (PEF) rate and the partial pressure of oxygen in arterial blood (PaO₂) were measured in 71 patients with the chief complaint of dyspnea. The patients were treated in the hospital, and the final diagnosis (cardiac or pulmonary) of the cause of dyspnea was made at discharge. We defined a new measure, the dyspnea differentiation index (DDI), as (PEF x PaO₂)/1,000. We performed a receiver operating characteristic (ROC) curve analysis of the data to define the measure that best distinguished cardiac from pulmonary dyspnea. The curves also allowed us to establish an optimal cut-off point to distinguish between cardiac and pulmonary dyspnea.

Results: Patients with pulmonary dyspnea had a significantly lower mean PEF than patients with cardiac dyspnea (144 ± 66 vs 267 ± 97 L/min, respectively; p < 0.001). They also had a lower DDI than patients with cardiac dyspnea (8.4 ± 4.0 vs 18.4 ± 7.9 L-mm/min, respectively; p < 0.001). These two measures, PEF and DDI, also best distinguished pulmonary from cardiac dyspnea. PEF was able to diagnose the correct cause of dyspnea in 72% of patients, and DDI was correct in 79% of patients. This compares favorably to the performance of the emergency department physicians, who were able to predict the correct diagnosis in only 69% of patients.

Conclusion: These results demonstrate that the PEF by itself is useful in differentiating between cardiac and pulmonary causes of dyspnea, but that the calculation of DDI is superior in this regard.

Key Words: cardiac dyspnea • differentiation of dyspnea • dyspnea differentiation index • peak expiratory flow rate • pulmonary dyspnea

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