Utility of History, Physical Examination, Electrocardiogram, and ...
Utility of History, Physical Examination, Electrocardiogram, and ...
Utility of History, Physical Examination, Electrocardiogram, and ...
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Table 2. Sensitivity, Specificity, <strong>and</strong> Positive <strong>and</strong> Negative Predictive Values <strong>of</strong> Clinical Findings for Normal Systolic Function<br />
(Ejection Fraction 45%)<br />
hypertrophy <strong>and</strong> left atrial abnormality were significantly<br />
more common in those with decreased systolic function.<br />
Radiographic cardiomegaly <strong>and</strong> flow cephalization were<br />
significantly more common in patients with decreased<br />
function, whereas rates <strong>of</strong> pleural effusion <strong>and</strong> pulmonary<br />
edema were similar.<br />
Some clinical parameters had a high sensitivity or a<br />
high specificity for normal systolic function, but none<br />
had both a high sensitivity <strong>and</strong> a high specificity (Table 2).<br />
No clinical parameters had a high positive or negative<br />
Clinical Findings in Heart Failure/Thomas et al<br />
Sensitivity Specificity<br />
Positive<br />
Predictive Value<br />
Negative<br />
Predictive Value<br />
Percentage<br />
Historical factors<br />
Age 60 years 52 61 53 60<br />
Female sex 56 65 58 63<br />
Hypertension 78 26 48 57<br />
Diabetes mellitus 40 66 51 56<br />
Hyperlipidemia 6 94 46 53<br />
Smoking 39 55 43 51<br />
<strong>History</strong> <strong>of</strong> coronary disease 22 70 39 51<br />
Chronic renal failure 15 91 59 55<br />
Alcohol use<br />
Symptoms<br />
20 63 32 48<br />
Dyspnea at rest 39 56 42 52<br />
Dyspnea on exertion 98 2 46 50<br />
Orthopnea 86 14 47 55<br />
Paroxysmal nocturnal dyspnea 74 23 45 50<br />
Angina 4 89 24 52<br />
Nonanginal chest pain<br />
<strong>Physical</strong> examination<br />
37 74 54 57<br />
Body mass index 30 kg/m 2<br />
62 52 54 60<br />
Heart rate 100 beats per minute 31 50 34 45<br />
Systolic blood pressure 160 mm Hg 50 73 62 63<br />
Diastolic blood pressure 110 mm Hg 25 87 63 57<br />
Pulse pressure 60 mm Hg 61 55 54 62<br />
Jugular venous distention 72 26 46 53<br />
Pedal edema 83 25 48 63<br />
Rales 80 11 43 38<br />
S3 gallop 28 59 37 49<br />
S4 gallop<br />
<strong>Electrocardiogram</strong><br />
11 93 56 55<br />
Atrial fibrillation 19 90 61 57<br />
Abnormal Q waves 18 79 42 53<br />
Left ventricular hypertrophy 22 58 31 47<br />
Left atrial abnormality<br />
Chest radiograph<br />
22 48 25 45<br />
Cardiomegaly 86 7 45 36<br />
Cephalization 79 9 43 34<br />
Pleural effusion 26 81 55 56<br />
Pulmonary edema 14 85 45 53<br />
440 April 15, 2002 THE AMERICAN JOURNAL OF MEDICINE Volume 112<br />
predictive value for differentiating normal from decreased<br />
systolic function.<br />
In a multivariate analysis, several clinical findings were<br />
independent predictors <strong>of</strong> normal systolic function, including<br />
female sex (odds ratio [OR] 2.3; 95% confidence<br />
interval [CI]: 1.3 to 4.2; P 0.03), heart rate 100<br />
beats per minute (OR 1.9; 95% CI: 1.1 to 3.9; P <br />
0.005), use <strong>of</strong> ACE inhibitors (OR 0.34; 95% CI: 0.17 to<br />
0.67; P 0.001), <strong>and</strong> use <strong>of</strong> digoxin (OR 0.35; 95% CI:<br />
0.20 to 0.66; P 0.03). The area under the receiver oper-