The value of the electrocardiogram and chest X‐ray for confirming or refuting a suspected diagnosis of heart failure in the community

Abstract

Background: There is a common assumption that a normal ECG or a normal heart size on chest X-ray virtually rules out a diagnosis of heart failure. Aims: To assess the value of the electrocardiogram and chest X-ray in identifying patients with chronic heart failure in the community. Methods and results: This study was a secondary analysis of data prospectively collected at the time of patient's enrolment in the EPICA study, an epidemiological study of the prevalence of heart failure in Portugal. A total of 6300 subjects were clinically evaluated. Patients who presented with symptoms or signs of heart failure, and/or were receiving diuretics for chronic heart failure (CHF) had a chest X-ray, ECG, and echocardiogram. The diagnosis of heart failure was confirmed in 551 cases. Patients with right atrial enlargement, atrial flutter, atrial fibrillation, 2nd degree-Mobitz I atrioventricular block, 1st degree atrioventricular block, left bundle branch block, lung interstitial oedema, and bilateral pleural effusion were more likely to be diagnosed with heart failure. For the diagnosis of heart failure, in the Portuguese population aged over 25 years, an abnormal electrocardiogram had an estimated sensitivity of 81%, and negative predictive value of 75%; an abnormal chest X-ray had an estimated sensitivity of 57%, and negative predictive value of 83%. Twenty five percent of patients with CHF had a normal ECG or chest X-ray. Conclusion: Our results show that electrocardiographic and roentgenographic features are not sufficient to allow heart failure to be reliably predicted in the community and support the recommendation that all patients with suspected heart failure should undergo echocardiography.

Comparison of a basic lung scanning protocol against formally reported chest x‐ray in the diagnosis of pulmonary oedema

“…In the EPICA study, blinded cardiologist and radiologist reporting of chest x‐rays for possible heart failure demonstrated a diagnostic accuracy of 61% (recalculated from the raw figures) 3 . In the BASEL study, immediate routine radiologist reports had a sensitivity of 53.3% and a specificity of 86.3% with an overall diagnostic accuracy of 68.8% 8 for the diagnosis of heart failure.…”

Clinical Study of Cardiovascular Involvement in Patients with Connective Tissue Diseases

“…A chest X-ray is widely used in the diagnosis of cardiovascular radiographic examination. The presence of different signs was evaluated using chest X-ray including upper zone flow redistribution, lung interstitial edema, alveolar pulmonary edema, bilateral pleural effusion, and cardiomegaly [11]. However, echocardiography has a higher sensitivity for detection of cardiovascular disease [12].…”

“…Antinuclear antibodies (ANA) and anti-double stranded DNA antibodies (anti-dsDNA) antibodies are considered useful in the diagnosis and assessment of the disease activity in RA and SLE patients [9]. Non-invasive techniques which include electrocardiogram (ECG), chest X-ray and echocardiography are the particular processes in detecting cardiovascular abnormalities [10] [11]. ECG is commonly the primary examination for diagnosing cardiovascular disease.…”

Diagnosing heart failure in primary care: lessons from EPICA

“…The four papers from the EPICA study [7][8][9][10] together with the main paper published previously [11] make an important contribution to the diagnosis and epidemiology of heart failure. The papers are of international significance as well as providing specific information on the Portuguese population.…”

“…Table 1 provides the criteria used in these questionnaires to supplement the paper [12]. The paper on the diagnostic value of the ECG and chest X-ray is probably the largest study of its kind and provides robust evidence upon which to base decision making [9]. The paper on the treatment of heart failure shows that standards of care for heart failure in Portugal, like other nations belonging to the ESC, are suboptimal [8].…”