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Risk assessment of left ventricular systolic dysfunction in primary care: cross sectional study evaluating a range of
O W Nielsen1, J F Hansen, J Hilden
1Cardiovascular Department, Copenhagen University Hospital Hvidovre, DK-2650 Hvidovre, Denmark. own@dadlnet.dk
Insights
A normal electrocardiogram indicates a low risk of left ventricular systolic dysfunction. Specific clinical factors can help identify patients needing further echocardiography for heart condition assessment.
Area of Science:
- Cardiology
- Diagnostic Medicine
- Primary Care
Background:
- Left ventricular systolic dysfunction (LVSD) is a critical indicator of cardiac health.
- Early identification of LVSD is crucial for timely intervention and improved patient outcomes.
- Current diagnostic methods like echocardiography can be resource-intensive.
Purpose of the Study:
- To evaluate the probability of diagnosing left ventricular systolic dysfunction in general practice patients without relying on echocardiography.
- To identify key clinical variables that predict LVSD in a primary care setting.
Main Methods:
- A cross-sectional study was conducted in three general practices in Copenhagen.
- 2158 patients over 40 were screened; 126 eligible patients with cardiac signs/symptoms underwent examination.
- Multivariate regression models analyzed the relationship between clinical variables and LVSD, confirmed by echocardiography.
Main Results:
- Left ventricular systolic dysfunction was present in 12% of the study cohort.
- Electrocardiogram abnormalities (Q waves, LBBB, ST-T changes), heart rate exceeding diastolic blood pressure, and elevated N-terminal atrial natriuretic peptide levels were significant predictors.
- A normal electrocardiogram was associated with a very low risk (2%) of LVSD.
Conclusions:
- A normal electrocardiogram strongly suggests a low risk for left ventricular systolic dysfunction.
- Patients at higher risk can be identified using a combination of electrocardiogram findings, elevated natriuretic peptide levels, or heart rate/blood pressure ratios, guiding the need for echocardiography.
Objectives:
To assess the probability of left ventricular systolic dysfunction without echocardiography in patients from general practice.
Design:
Cross sectional study using multivariate regression models to examine the relation between clinical variables and left ventricular systolic dysfunction as determined by echocardiography.
Setting:
Three general practices in Copenhagen.
Subjects:
2158 patients aged >40 years were screened by questionnaires and case record reviews; 357 patients with past or present signs or symptoms of heart disease were identified, of whom 126 were eligible for and consented to examination.
Main Outcome Measures:
Clinical variables that were significantly (P<0.05) related to ejection fraction
Results:
15 patients (12%) had left ventricular systolic dysfunction. The prevalence was significantly related to three questions: does the electrocardiogram have Q waves, left bundle branch block, or ST-T segment changes? (P=0.012); is resting supine heart rate greater than the simultaneous diastolic blood pressure? (P=0.002); and is plasma N-terminal atrial natriuretic peptide>0.8 nmol/l? (P=0.040)? Only one of 60 patients with a normal electrocardiogram had systolic dysfunction (2%, 95% confidence interval 0% to 9%) regardless of response to the other two questions. The risk of dysfunction was appreciable in patients with a yes answer to two or three questions (50%, 27% to 73%).
Conclusions:
A normal electrocardiogram implies a low risk of left ventricular systolic dysfunction. Patients can be identified for echocardiography on the basis of an abnormal electrocardiogram combined with increased natriuretic peptide concentration or a heart rate greater than diastolic blood pressure, or both.