BACKGROUND: Previous validation studies of congestive heart failure (CHF) signs and symptoms were performed in acute settings. Few data have supported the validity of CHF clinical findings during the chronic stages of the disease. This study was designed to evaluate the reliability and prognostic value of traditional signs and symptoms in stable CHF outpatients. METHODS: Sixty CHF outpatients who underwent 102 simultaneous clinical and echocardiographic evaluations were prospectively examined. A clinical congestion score was built summing all grades of CHF signs and symptoms. Hemodynamic parameters were estimated according to previously validated echocardiography-based protocols. Major cardiac events were evaluated after 180 days. RESULTS: Most CHF patients were male (67%), middle-aged (56+/-15 years) and in Specific Activity Scale functional classes I to II (70%). Isolated clinical findings demonstrated limited sensitivity and specificity to identify hemodynamic parameters. Absence of all signs of congestion, however, had a predictive value of 95% for a left atrial pressure less than 20 mmHg. Patients with no CHF signs or symptoms (score of 0) had significantly lower right (P<0.001) and left (P=0.03) atrial pressures compared with those with higher scores (scores of at least 5). In multivariate analysis, a congestion score of at least 3 (RR 4.8, 95% CI 1.3 to 17.4, P=0.02) and beta-blockers use (P=0.02) remained associated with future cardiac events. CONCLUSIONS: Although CHF signs and symptoms did not accurately identify hemodynamic parameters, combined data from history and physical examination provided meaningful information to guide clinical decisions and for prognostication.
BACKGROUND: Previous validation studies of congestive heart failure (CHF) signs and symptoms were performed in acute settings. Few data have supported the validity of CHF clinical findings during the chronic stages of the disease. This study was designed to evaluate the reliability and prognostic value of traditional signs and symptoms in stable CHF outpatients. METHODS: Sixty CHF outpatients who underwent 102 simultaneous clinical and echocardiographic evaluations were prospectively examined. A clinical congestion score was built summing all grades of CHF signs and symptoms. Hemodynamic parameters were estimated according to previously validated echocardiography-based protocols. Major cardiac events were evaluated after 180 days. RESULTS: Most CHFpatients were male (67%), middle-aged (56+/-15 years) and in Specific Activity Scale functional classes I to II (70%). Isolated clinical findings demonstrated limited sensitivity and specificity to identify hemodynamic parameters. Absence of all signs of congestion, however, had a predictive value of 95% for a left atrial pressure less than 20 mmHg. Patients with no CHF signs or symptoms (score of 0) had significantly lower right (P<0.001) and left (P=0.03) atrial pressures compared with those with higher scores (scores of at least 5). In multivariate analysis, a congestion score of at least 3 (RR 4.8, 95% CI 1.3 to 17.4, P=0.02) and beta-blockers use (P=0.02) remained associated with future cardiac events. CONCLUSIONS: Although CHF signs and symptoms did not accurately identify hemodynamic parameters, combined data from history and physical examination provided meaningful information to guide clinical decisions and for prognostication.
Authors: Gaspare Parrinello; Stephen J Greene; Daniele Torres; Michael Alderman; Joseph Vincent Bonventre; Pietro Di Pasquale; Luna Gargani; Anju Nohria; Gregg C Fonarow; Muthiah Vaduganathan; Javed Butler; Salvatore Paterna; Lynne Warner Stevenson; Mihai Gheorghiade Journal: Heart Fail Rev Date: 2015-01 Impact factor: 4.214