Heart failure: clinical features could help diagnose and exclude left ventricular dysfunction.

Clinical bottom line (level 4)

  1. One in six patients with suspected chronic heart failure referred for echocardiography had left ventricular systolic dysfunction.
  2. LV dysfunction was more likely with
    • a gallop rhythm (LR+27)
    • a displaced apex (LR+16)
    • jugular venous distension (LR+9.3)
    • a previous myocardial infarction (LR+4.1)
  3. LV dysfunction was less likely with no dyspnoea on exertion (LR-0.0) .
Davie et al: Quarterly Journal of Medicine 1997; 90: 335-339
Expires December 2003

The study

Setting: acute hospital, UK

259 patients (aged ?, ?% male) with suspected chronic heart failure referred for echocardiography with a view to ACE inhibitor therapy

Independent blinded reference standard, applied in all patients from a consecutive inappropriate spectrum.
Reference standard:
  • echocardiography
Diagnostic test: clinical signs and symptoms

The evidence

pre-test probability of left ventricular systolic dysfunction: 16%, (95% CI: 11% to 20%)

diagnostic test left ventricular systolic failure no failure LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
gallop rhythm 10 2 27
(6.1 to 120) 		83% 0.76
(0.64 to 0.91) 		13%
apex displaced 27 9 16
(8.1 to 31) 		75% 0.36
(0.23 to 0.55) 		6%
myocardial infarction 24 31 4.1
(2.7 to 6.2) 		44% 0.48
(0.33 to 0.70) 		8%
jugular venous distension 7 4 9.3
(2.9 to 30) 		64% 0.84
(0.73 to 0.97) 		14%
paroxysmal nocturnal dyspnoea 16 44 1.9
(1.2 to 3.1) 		27% 0.76
(0.59 to 0.98) 		12%
dyspnoea on exertion 41 181 1.2
(1.1 to 1.3) 		18% 0.0
(0.0 to 0.084) 		0%
total 41 218

Comments

  1. No other clinical features were particularly helpful at diagnosing left ventricular systolic dysfunction.

Citation

  1. Davie AP, Francis CM, Caruana L, et al: assessing diagnosis in heart failure: which features are any use?. Quarterly Journal of Medicine 1997; 90: 335-339
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Contributor: Chris Ball and Clare Wotton, December 1999
Reviewer:

Clinical Question.
Patient suspected chronic heart failure
Intervention or Exposure clinical signs and symptoms
Outcome left ventricular systolic dysfunction