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.
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.
Authors: T A McDonagh; C E Morrison; A Lawrence; I Ford; H Tunstall-Pedoe; J J McMurray; H J Dargie Journal: Lancet Date: 1997-09-20 Impact factor: 79.321
Authors: T A McDonagh; S D Robb; D R Murdoch; J J Morton; I Ford; C E Morrison; H Tunstall-Pedoe; J J McMurray; H J Dargie Journal: Lancet Date: 1998-01-03 Impact factor: 79.321
Authors: M R Bristow; E M Gilbert; W T Abraham; K F Adams; M B Fowler; R E Hershberger; S H Kubo; K A Narahara; H Ingersoll; S Krueger; S Young; N Shusterman Journal: Circulation Date: 1996-12-01 Impact factor: 29.690
Authors: M R Cowie; A D Struthers; D A Wood; A J Coats; S G Thompson; P A Poole-Wilson; G C Sutton Journal: Lancet Date: 1997-11-08 Impact factor: 79.321