How well can the chest radiograph diagnose left ventricular dysfunction?

Badgett, Robert G.; Mulrow, Cynthia D.; Otto, Pamela M; Ramı́rez, Gilbert

doi:10.1007/bf02599031

Cited by 69 publications

(36 citation statements)

References 72 publications

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“…Badgett et al reviewed 29 studies and concluded that chest x-ray alone cannot adequately exclude or confirm left ventricular dysfunction in clinical settings. 29 According to several guidelines, a normal ECG rules out heart failure, based on the high negative predictive value (univariable) for echocardiographic systolic dysfunction of 98%, studied in a population with 18% systolic dysfunction and 51% normal ECG. 30 Others have also shown that a normal ECG may be useful to exclude heart failure.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure

et al. 2011

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Background-Early diagnosis of nonacute heart failure is crucial because prompt initiation of evidence-based treatment can prevent or slow down further progression. To diagnose new-onset heart failure in primary care is challenging. Methods and Results-This is a cross-sectional diagnostic accuracy study with external validation. Seven hundred twenty-one consecutive patients suspected of new-onset heart failure underwent standardized diagnostic work-up including chest x-ray, spirometry, ECG, N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement, and echocardiography in specially equipped outpatient diagnostic heart failure clinics. The presence of heart failure was determined by an outcome panel using the initial clinical data and 6-month follow-up data, blinded to biomarker data. Of the 721 patients, 207 (28.7%) had heart failure. The combination of 3 items from history (age, coronary artery disease, and loop diuretic use) plus 6 from physical examination (pulse rate and regularity, displaced apex beat, rales, heart murmur, and increased jugular vein pressure) showed independent diagnostic value (c-statistic 0.83). NT-proBNP was the most powerful supplementary diagnostic test, increasing the c-statistic to 0.86 and resulting in net reclassification improvement of 69% (PϽ0.0001). A simplified diagnostic rule was applied to 2 external validation datasets, resulting in c-statistics of 0.95 and 0.88, confirming the results. Conclusions-In this study, we estimated the quantitative diagnostic contribution of elements of the history and physical examination in the diagnosis of heart failure in primary care outpatients, which may help to improve clinical decision making. The largest additional quantitative diagnostic contribution to those elements was provided by measurement of NT-proBNP. For daily practice, a diagnostic rule was derived that may be useful to quantify the probability of heart failure in patients with new symptoms suggestive of heart failure. (Circulation. 2011;124:2865-2873.)

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Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure

et al. 2011

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“…The evidence base supporting the defi nition of some radiological diagnoses is incomplete. For example, vascular redistribution and cardiomegaly were identifi ed as radiological criteria for diagnosing cardiac failure in one study, 17 whereas another study found no value of radiographic fi ndings in diagnosing heart failure. 18 Local radiologists in the centers associated with each primary care network examined chest radiographs.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Vugt

Broekhuizen

Zuithoff

et al. 2012

The Annals of Family Medicine

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PURPOSE Imaging may produce unexpected or incidental fi ndings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental fi ndings are lacking. We set out to describe the type and prevalence of incidental chest radiography fi ndings in primary care patients with acute cough. METHODSWe report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specifi ed signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional fi nding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these fi ndings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. RESULTSIncidental fi ndings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental fi ndings. Suspected nodules and shadows were reported in 1.8%. Incidental fi ndings were more common is older participants and smokers (P <.001).CONCLUSIONS Clinically relevant incidental fi ndings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting. Ann Fam Med 2012;10:510-515. doi:10.1370/afm.1384. INTRODUCTIONA cute cough is one of the most common reasons for consulting in primary care. 1,2 Prompt, accurate diagnosis of pneumonia in these patients is important to rule in the need for timely appropriate antibiotic treatment in some patients and to rule out the need for antibiotic treatment in others. Responsible general practitioners order chest radiographs in a minority of patients with acute cough. 3 These radiographs confi rm pneumonia in 5% to 19% and exclude pneumonia in most patients. 2,4,5 Imaging provides information relevant to the acute illness but may also reveal incidental fi ndings. 6-9 Such fi ndings can benefi t patients through earlier diagnosis and treatment, for example, in as yet undiagnosed heart failure or malignancy. Incidental fi ndings, however, may have unknown or doubtful clinical relevance and lead to patient anxiety, expensive workup, and potentially harmful investigations and treatment without improving quality and length of life. 10,11 The nature and prevalence of incidental fi ndings on chest radiographs of patients who consult their general practitioner for acute cough is unknown. Such data may inform decisions about clinical indications for ordering chest radiographs. We studied incidental fi ndings on chest radiographs obtained METHODSWe undertook a cross-sectional observational study using data from the GRACE-09/10a study (Genomics to comba...

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“…We please ask them to read (or have translated in commercial terms) Chaps. 18,20,23,29, and give a new life to artifacts.…”

Section: One Word For the Attention Of The Manufacturersmentioning

confidence: 99%

“…Signs like vascular redistribution do not work in supine patients. X-ray sensitivity in detecting interstitial edema can range between 18% and 45% [18,19]. Kerley B-lines can be observed in exacerbation of COPD [20].…”

Section: Ultrasound Diagnosis Of Hemodynamic Pulmonary Edemamentioning

confidence: 99%

Lung and Interstitial Syndrome

Lichtenstein

2010

Whole Body Ultrasonography in the Critically Ill

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How well can the chest radiograph diagnose left ventricular dysfunction?

Cited by 69 publications

References 72 publications

The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure

The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Lung and Interstitial Syndrome

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