CROSS-SECTIONAL STUDY OF CONTRIBUTION OF CLINICAL-ASSESSMENT AND SIMPLE CARDIAC INVESTIGATIONS TO DIAGNOSIS OF LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION IN PATIENTS ADMITTED WITH ACUTE DYSPNEA

Objective: To assess the comparative contribution of clinical assessme nt, electrocardiography, and chest radiography to the diagnosis of lef t ventricular systolic dysfunction in patients admitted to a general m edical ward with acute dyspnoea Design: Prospective cross sectional st udy. Setting: Acute medical admissions ward of a teaching hospital. Su bjects: 71 randomly selected patients admitted with acute dyspnoea. Ma in outcome measures: Sensitivity and specificity of each investigation and logistic regression analysis of each variable in identifying left ventricular systolic dysfunction, Results: Clinical assessment in thi s cohort of patients with severe dyspnoea was generally sensitive (sen sitivity 81%), Patients were divided into three groups on the basis of clinical assessment In the first group (37 patients) the diagnosis of systolic dysfunction was clear, in the second (22) it was in doubt, a nd in the third (12) it was unlikely. The sensitivity of clinical asse ssment in identifying left ventricular systolic dysfunction was 81% an d the specificity was 41%, The specificity of diagnosis was improved b y electrocardiography (69%) and chest radiography (92%), Logistic regr ession analysis showed that isolated pulmonary crepitations were a com paratively poor predictor of left ventricular systolic dysfunction (ch i(2)=10.215, P=0.0014) but that a full clinical examination had reason able predictive value (chi(2)=24.82, P<0.00001). The combination of cl inical assessment and chest radiography improved the accuracy of diagn osis (chi(2)=28.08, P<0.00001), as did the combination of clinical ass essment and electrocardiography (chi(2)=32.41, P<0.00001), Conclusion: Clinical assessment in patients admitted with acute dyspnoea is compa ratively accurate, Patients with abnormal results on chest radiography , electrocardiography, and clinical examination have a high likelihood of having left ventricular systolic dysfunction. Echocardiography con tributes little more to the diagnosis in these patients and may be mor e efficiently directed towards patients in whom the diagnosis is still in doubt after clinical assessment, chest radiography, and electrocar diography.