The accuracy of symptoms, signs and diagnostic tests in the diagnosis of left ventricular dysfunction in primary care

A diagnostic accuracy systematic review

V. Madhok, G. Falk, A. Rogers, A. D. Struthers, F. M. Sullivan, T. Fahey

    Research output: Contribution to journalArticle

    20 Citations (Scopus)

    Abstract

    Background: To assess the accuracy of findings from the clinical history, symptoms, signs and diagnostic tests (ECG, CXR and natriuretic peptides) in relation to the diagnosis of left ventricular systolic dysfunction (LVSD) in a primary care setting.

    Methods: Diagnostic accuracy systematic review, we searched Medline (1966 to March 2008), EMBASE (1988 to March 2008), Central, Cochrane and ZETOC using a diagnostic accuracy search filter. We included cross-sectional or cohort studies that assess the diagnostic utility of clinical history, symptoms, signs and diagnostic tests, against a reference standard of echocardiography. We calculated pooled positive and negative likelihood ratios and assessed heterogeneity using the I-2 index.

    Results: 24 studies incorporating 10,710 patients were included. The median prevalence of LVSD was 29.9% (inter-quartile range 14% to 37%). No item from the clinical history or symptoms provided sufficient diagnostic information to "rule in" or "rule out" LVSD. Displaced apex beat shows a convincing diagnostic effect with a pooled positive likelihood ratio of 16.0 (8.2-30.9) but this finding occurs infrequently in patients. ECG was the most widely studied diagnostic test, the negative likelihood ratio ranging from 0.06 to 0.6. Natriuretic peptide results were strongly heterogeneous, with negative likelihood ratios ranging from 0.02 to 0.80.

    Conclusion: Findings from the clinical history and examination are insufficient to "rule in" or "rule out" a diagnosis of LVSD in primary care settings. BNP and ECG measurement appear to have similar diagnostic utility and are most useful in "ruling out" LVSD with a normal test result when the probability of LVSD is in the intermediate range.

    Original languageEnglish
    Article number56
    Pages (from-to)-
    Number of pages8
    JournalBMC Family Practice
    Volume9
    DOIs
    Publication statusPublished - 8 Oct 2008

    Keywords

    • SUSPECTED HEART-FAILURE
    • BRAIN NATRIURETIC PEPTIDE
    • OPEN ACCESS ECHOCARDIOGRAPHY
    • N-TERMINAL-PROBNP
    • SYSTOLIC DYSFUNCTION
    • CARDIAC DYSFUNCTION
    • ELDERLY-PATIENTS
    • GENERAL-PRACTICE
    • HEALTH-CARE
    • COMMUNITY

    Cite this

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    title = "The accuracy of symptoms, signs and diagnostic tests in the diagnosis of left ventricular dysfunction in primary care: A diagnostic accuracy systematic review",
    abstract = "Background: To assess the accuracy of findings from the clinical history, symptoms, signs and diagnostic tests (ECG, CXR and natriuretic peptides) in relation to the diagnosis of left ventricular systolic dysfunction (LVSD) in a primary care setting.Methods: Diagnostic accuracy systematic review, we searched Medline (1966 to March 2008), EMBASE (1988 to March 2008), Central, Cochrane and ZETOC using a diagnostic accuracy search filter. We included cross-sectional or cohort studies that assess the diagnostic utility of clinical history, symptoms, signs and diagnostic tests, against a reference standard of echocardiography. We calculated pooled positive and negative likelihood ratios and assessed heterogeneity using the I-2 index.Results: 24 studies incorporating 10,710 patients were included. The median prevalence of LVSD was 29.9{\%} (inter-quartile range 14{\%} to 37{\%}). No item from the clinical history or symptoms provided sufficient diagnostic information to {"}rule in{"} or {"}rule out{"} LVSD. Displaced apex beat shows a convincing diagnostic effect with a pooled positive likelihood ratio of 16.0 (8.2-30.9) but this finding occurs infrequently in patients. ECG was the most widely studied diagnostic test, the negative likelihood ratio ranging from 0.06 to 0.6. Natriuretic peptide results were strongly heterogeneous, with negative likelihood ratios ranging from 0.02 to 0.80.Conclusion: Findings from the clinical history and examination are insufficient to {"}rule in{"} or {"}rule out{"} a diagnosis of LVSD in primary care settings. BNP and ECG measurement appear to have similar diagnostic utility and are most useful in {"}ruling out{"} LVSD with a normal test result when the probability of LVSD is in the intermediate range.",
    keywords = "SUSPECTED HEART-FAILURE, BRAIN NATRIURETIC PEPTIDE, OPEN ACCESS ECHOCARDIOGRAPHY, N-TERMINAL-PROBNP, SYSTOLIC DYSFUNCTION, CARDIAC DYSFUNCTION, ELDERLY-PATIENTS, GENERAL-PRACTICE, HEALTH-CARE, COMMUNITY",
    author = "V. Madhok and G. Falk and A. Rogers and Struthers, {A. D.} and Sullivan, {F. M.} and T. Fahey",
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    language = "English",
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    The accuracy of symptoms, signs and diagnostic tests in the diagnosis of left ventricular dysfunction in primary care : A diagnostic accuracy systematic review. / Madhok, V.; Falk, G.; Rogers, A.; Struthers, A. D.; Sullivan, F. M.; Fahey, T.

    In: BMC Family Practice, Vol. 9, 56, 08.10.2008, p. -.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - The accuracy of symptoms, signs and diagnostic tests in the diagnosis of left ventricular dysfunction in primary care

    T2 - A diagnostic accuracy systematic review

    AU - Madhok, V.

    AU - Falk, G.

    AU - Rogers, A.

    AU - Struthers, A. D.

    AU - Sullivan, F. M.

    AU - Fahey, T.

    PY - 2008/10/8

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    N2 - Background: To assess the accuracy of findings from the clinical history, symptoms, signs and diagnostic tests (ECG, CXR and natriuretic peptides) in relation to the diagnosis of left ventricular systolic dysfunction (LVSD) in a primary care setting.Methods: Diagnostic accuracy systematic review, we searched Medline (1966 to March 2008), EMBASE (1988 to March 2008), Central, Cochrane and ZETOC using a diagnostic accuracy search filter. We included cross-sectional or cohort studies that assess the diagnostic utility of clinical history, symptoms, signs and diagnostic tests, against a reference standard of echocardiography. We calculated pooled positive and negative likelihood ratios and assessed heterogeneity using the I-2 index.Results: 24 studies incorporating 10,710 patients were included. The median prevalence of LVSD was 29.9% (inter-quartile range 14% to 37%). No item from the clinical history or symptoms provided sufficient diagnostic information to "rule in" or "rule out" LVSD. Displaced apex beat shows a convincing diagnostic effect with a pooled positive likelihood ratio of 16.0 (8.2-30.9) but this finding occurs infrequently in patients. ECG was the most widely studied diagnostic test, the negative likelihood ratio ranging from 0.06 to 0.6. Natriuretic peptide results were strongly heterogeneous, with negative likelihood ratios ranging from 0.02 to 0.80.Conclusion: Findings from the clinical history and examination are insufficient to "rule in" or "rule out" a diagnosis of LVSD in primary care settings. BNP and ECG measurement appear to have similar diagnostic utility and are most useful in "ruling out" LVSD with a normal test result when the probability of LVSD is in the intermediate range.

    AB - Background: To assess the accuracy of findings from the clinical history, symptoms, signs and diagnostic tests (ECG, CXR and natriuretic peptides) in relation to the diagnosis of left ventricular systolic dysfunction (LVSD) in a primary care setting.Methods: Diagnostic accuracy systematic review, we searched Medline (1966 to March 2008), EMBASE (1988 to March 2008), Central, Cochrane and ZETOC using a diagnostic accuracy search filter. We included cross-sectional or cohort studies that assess the diagnostic utility of clinical history, symptoms, signs and diagnostic tests, against a reference standard of echocardiography. We calculated pooled positive and negative likelihood ratios and assessed heterogeneity using the I-2 index.Results: 24 studies incorporating 10,710 patients were included. The median prevalence of LVSD was 29.9% (inter-quartile range 14% to 37%). No item from the clinical history or symptoms provided sufficient diagnostic information to "rule in" or "rule out" LVSD. Displaced apex beat shows a convincing diagnostic effect with a pooled positive likelihood ratio of 16.0 (8.2-30.9) but this finding occurs infrequently in patients. ECG was the most widely studied diagnostic test, the negative likelihood ratio ranging from 0.06 to 0.6. Natriuretic peptide results were strongly heterogeneous, with negative likelihood ratios ranging from 0.02 to 0.80.Conclusion: Findings from the clinical history and examination are insufficient to "rule in" or "rule out" a diagnosis of LVSD in primary care settings. BNP and ECG measurement appear to have similar diagnostic utility and are most useful in "ruling out" LVSD with a normal test result when the probability of LVSD is in the intermediate range.

    KW - SUSPECTED HEART-FAILURE

    KW - BRAIN NATRIURETIC PEPTIDE

    KW - OPEN ACCESS ECHOCARDIOGRAPHY

    KW - N-TERMINAL-PROBNP

    KW - SYSTOLIC DYSFUNCTION

    KW - CARDIAC DYSFUNCTION

    KW - ELDERLY-PATIENTS

    KW - GENERAL-PRACTICE

    KW - HEALTH-CARE

    KW - COMMUNITY

    U2 - 10.1186/1471-2296-9-56

    DO - 10.1186/1471-2296-9-56

    M3 - Article

    VL - 9

    SP - -

    JO - BMC Family Practice

    JF - BMC Family Practice

    SN - 1471-2296

    M1 - 56

    ER -