Electrocardiograph and chest X-ray in prediction of left ventricular systolic dysfunction

Area of Science:

• Cardiology
• Diagnostic Imaging
• Primary Care Medicine

Background:

• Echocardiography is the gold standard for diagnosing left ventricular systolic dysfunction (LVSD).
• However, echocardiography's cost and manpower requirements limit its availability in primary care.
• Basic investigations like ECG and Chest X-ray may aid in LVSD diagnosis or patient selection for echocardiography.

Purpose of the Study:

• To evaluate the utility of ECG and Chest X-ray in diagnosing LVSD in a primary care context.
• To compare the diagnostic accuracy of ECG and Chest X-ray with echocardiography for LVSD.
• To determine if ECG and Chest X-ray can effectively streamline the need for echocardiography.

Main Methods:

• 35 patients with cardiac complaints underwent clinical assessment, ECG, Chest X-ray, and echocardiography.
• Findings from ECG and Chest X-ray regarding systolic function were compared against echocardiography results.
• Sensitivity, specificity, and positive predictive values were calculated for specific ECG abnormalities and cardiothoracic ratio.

Main Results:

• 25 out of 35 participants had LVSD (ejection fraction < 45%).
• Abnormal ECGs (sensitivity 100%, specificity 70%) and cardiomegaly on Chest X-ray (sensitivity 92%, specificity 30%) were common.
• Specific ECG abnormalities showed high sensitivity and PPV for LVSD diagnosis; cardiothoracic ratio > 0.5 showed high sensitivity.

Conclusions:

• ECG and Chest X-ray cannot replace echocardiography for definitive LVSD diagnosis.
• These basic investigations can provide valuable information about systolic function in primary care.
• ECG and Chest X-ray can help identify patients who would benefit most from echocardiography.