ASSESSING DIAGNOSIS IN HEART-FAILURE - WHICH FEATURES ARE ANY USE

We assessed the value of symptoms, past history, medications and signs in the evaluation of patients who might have heart failure secondary to left ventricular systolic dysfunction. An open-access echocardiogra phy service was set up to help identify patients with left ventricular systolic dysfunction who might benefit from treatment with an angiote nsin-converting-enzyme inhibitor. History and examination were recorde d for each of these patients. The patients were divided into groups ac cording to whether left ventricular systolic function was preserved or not and whether various clinical features were present or not. Of 259 consecutive patients studied, 41 had impairment of left ventricular s ystolic function as assessed by echocardiography. Past history of myoc ardial infarction and displaced apex beat were the best single predict ors of left ventricular systolic dysfunction as assessed by echocardio graphy. The combination of past history of myocardial infarction and d isplaced apex had the best positive predictive value of ail. Patients with such clinical features or combinations of clinical features may n ot need echocardiography, and where access to this resource is limited , it could be reserved for patients without such diagnostic features.