Echocardiography and the clinical diagnosis of left ventricular dysfunction

The added value of routine echocardiography, in respect to clinical examination and ECG, has received little attention. We sought to evaluate the contribution of two-dimensional echocardiography, in respect to clinical examination and ECG, in detecting left ventricular (LV) dilatation and systolic dysfunction.

A group of 100 patients, scheduled for cardiac magnetic resonance imaging (MRI), was prospectively studied.

Clinical examination identified moderate-to-severe LV dysfunction, defined as a LV ejection fraction (EF) < 45% at MRI, with a sensitivity of 62% and a specificity of 68%. After ECG, sensitivity and specificity slightly improved (71 and 70%, respectively). After the echocardiographic report, sensitivity reached 84% and specificity 90%. LV EF by echocardiography (routine studies) was closely related with that by MRI (r = 0.84). LV function was scored as undefined in 17% of patients after clinical examination, in 5% of patients after ECG and in no patient after echocardiography (P < 0.0001). Clinical examination identified patients with LV dilatation (LV end-diastolic volume > or = 110 ml/m2) with a poor sensitivity (33%) but a good specificity (88%). After ECG, sensitivity was 39% and specificity 87%; after echocardiography, sensitivity reached 53% and specificity 92%.

Echocardiography provides information on LV function and dimensions that vastly exceeds that obtained by clinical examination and ECG. This study supports the use of echocardiography to improve patient diagnosis and management after history and physical examination.