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Assessing diagnosis in heart failure: which features are any use?
A P Davie1, C M Francis, L Caruana
1Department of Cardiology, Western General Hospital, Edinburgh, UK.
Insights
Diagnosing heart failure due to left ventricular systolic dysfunction can be aided by specific clinical signs. A history of myocardial infarction and a displaced apex beat are strong indicators, potentially reducing the need for echocardiography.
Area of Science:
- Cardiology
- Diagnostic Medicine
- Medical Imaging
Background:
- Heart failure secondary to left ventricular systolic dysfunction (LVSD) requires accurate diagnosis for effective treatment, often involving angiotensin-converting-enzyme inhibitors.
- Clinical evaluation, including symptoms, past medical history, medications, and physical examination findings, plays a crucial role in identifying patients with potential LVSD.
Purpose of the Study:
- To assess the diagnostic value of clinical features in identifying patients with heart failure secondary to LVSD.
- To determine if specific clinical findings can predict LVSD, thereby guiding the use of echocardiography services.
Main Methods:
- A prospective study of 259 consecutive patients referred to an open-access echocardiography service.
- Recording of patient history, medications, and physical examination findings.
- Classification of patients based on echocardiographic assessment of left ventricular systolic function (preserved vs. impaired) and presence of clinical features.
Main Results:
- Echocardiography identified LVSD in 41 out of 259 patients.
- A past history of myocardial infarction and a displaced apex beat were the strongest individual clinical predictors of LVSD.
- The combination of a past myocardial infarction history and a displaced apex beat demonstrated the highest positive predictive value for LVSD.
Conclusions:
- Clinical assessment, particularly a history of myocardial infarction and displaced apex beat, is valuable in diagnosing LVSD.
- These key clinical features can help identify patients likely to have LVSD, potentially obviating the need for echocardiography.
- In resource-limited settings, echocardiography can be prioritized for patients lacking these specific diagnostic clinical indicators.
Abstract:
We assessed the value of symptoms, past history, medications and signs in the evaluation of patients who might have heart failure secondary to left ventricular systolic dysfunction. An open-access echocardiography service was set up to help identify patients with left ventricular systolic dysfunction who might benefit from treatment with an angiotensin-converting-enzyme inhibitor. History and examination were recorded for each of these patients. The patients were divided into groups according to whether left ventricular systolic function was preserved or not and whether various clinical features were present or not. Of 259 consecutive patients studied, 41 had impairment of left ventricular systolic function as assessed by echocardiography. Past history of myocardial infarction and displaced apex beat were the best single predictors of left ventricular systolic dysfunction as assessed by echocardiography. The combination of past history of myocardial infarction and displaced apex had the best positive predictive value of all. Patients with such clinical features or combinations of clinical features may not need echocardiography, and where access to this resource is limited, it could be reserved for patients without such diagnostic features.