Assessing diagnosis in heart failure: which features are any use?

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.