Risk assessment of left ventricular systolic dysfunction in primary care: cross sectional study evaluating a range of diagnostic tests

Abstract

Objectives To assess the probability of left ventricular systolic dysfunction without echocardiography in patients from general practice. Design Cross sectional study using multivariate regression models to examine the relation between clinical variables and left ventricular systolic dysfunction as determined by echocardiography. Setting Three general practices in Copenhagen. Subjects 2158 patients aged > 40 years were screened by questionnaires and case record reviews; 357 patients with past or present signs or symptoms of heart disease were identified, of whom 126 were eligible for and consented to examination. Main outcome measures Clinical variables that were significantly (P < 0.05) related to ejection fraction <0.45 and their predictive value for left ventricular systolic dysfunction. Results 15 patients (12%) had left ventricular systolic dysfunction. The prevalence was significantly related to three questions: does the electrocardiogram have Q waves, left bundle branch block, or ST-T segment changes? (P = 0.012); is resting supine heart rate greater than the simultaneous diastolic blood pressure? (P = 0.002); and is plasma N-terminal atrial natriuretic peptide > 0.8 nmol/l? (P = 0.040)? Only one of 60 patients with a normal electrocardiogram had systolic dysfunction (2%, 95% confidence interval 0% to 9%) regardless of response to the other two questions. The risk of dysfunction was appreciable in patients with a yes answer to two or three questions (50%, 27% to 73%). Conclusions A normal electrocardiogram implies a low risk of left ventricular systolic dysfunction. Patients can be identified for echocardiography on the basis of an abnormal electrocardiogram combined with increased natriuretic peptide concentration or a heart rate greater than diastolic blood pressure, or both.

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

“…30 Others have also shown that a normal ECG may be useful to exclude heart failure. 5,31 In the present study, the negative predictive value was 94% in a population with 24% systolic dysfunction and only 27% normal ECGs. In our study, an ECG added significant diagnostic accuracy to readily available diagnostic tests (model 2c) even when NT-proBNP was included in the model (3c).…”

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

“…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. We aimed for uniform assessments through the use of a protocol for reporting abnormalities in the chest radiographs.…”

N-Terminal Pro-B-Type Natriuretic Peptide as an Indicator of Possible Cardiovascular Disease in Severely Obese Individuals: Comparison with Patients in Different Stages of Heart Failure

“…We intended to use NT-proBNP testing, which can basically be done during routine blood sampling, as a reliable and fast means of risk stratification for mild forms of HF in obesity. Obviously increased NT-proBNP could be an indicator for further and more intense diagnostic procedures because even in nonobese patients with an abnormal electrocardiogram, Nielsen et al (27 ) considered the probability of left ventricular systolic dysfunction based on the combined use of diastolic blood pressure and NT-proBNP concentration without echocardiography. This protocol was accurate enough to identify patients who should be referred to echocardiography (27 ).…”