The role of medical history and physical examination in the diagnosis of cardiac dysfunction seems to be progressively replaced by imaging technologies and laboratory investigations. The aim of this study was to evaluate whether symptoms and signs still provide clues for the diagnosis of left ventricular (LV) dysfunction, independently made by cardiac magnetic resonance imaging (MRI). A group of 90 patients in stable clinical conditions and scheduled for cardiac MRI was prospectively examined by two experienced cardiologists, who were unaware of patient conditions and indications to MRI. Patients were questioned regarding their history of dyspnoea on exertion, orthopnea, paroxysmal nocturnal dyspnoea, nocturia, cough, fatigue and sweating; patients also underwent general physical examination, inspection and palpation of the chest and auscultation of the heart and lungs. Left ventricular ejection fraction (EF) by MRI was 48 ± 16% (range 13 - 76%). The variables associated with a lower LV EF at univariate analysis were the following: dyspnea on ordinary or less-than-ordinary exertion (p < 0.01), orthopnea (p < 0.01), nocturia (p < 0.05), jugular venous distention (p < 0.05), hepatomegaly (p < 0.005), prominent point of maximal impulse (p = 0.01) and mitral systolic murmur (p < 0.005). However, only orthopnea, sweating, mitral systolic murmur and hepatomegaly were independent predictors of a reduced LV function (EF < 45%) at multiple logistic regression (p< 0.001). The combination of above variables was able to correctly classify 81% of the patients and to detect a reduced EF with a sensitivity of 73% and a specificity of 85%. Thus, symptoms and signs still predict LV dysfunction and should be utilized as a first step in the diagnostic process.

Symptoms and signs of left ventricular dysfunction in the technology era

DI BELLA, Gianluca;
2006-01-01

Abstract

The role of medical history and physical examination in the diagnosis of cardiac dysfunction seems to be progressively replaced by imaging technologies and laboratory investigations. The aim of this study was to evaluate whether symptoms and signs still provide clues for the diagnosis of left ventricular (LV) dysfunction, independently made by cardiac magnetic resonance imaging (MRI). A group of 90 patients in stable clinical conditions and scheduled for cardiac MRI was prospectively examined by two experienced cardiologists, who were unaware of patient conditions and indications to MRI. Patients were questioned regarding their history of dyspnoea on exertion, orthopnea, paroxysmal nocturnal dyspnoea, nocturia, cough, fatigue and sweating; patients also underwent general physical examination, inspection and palpation of the chest and auscultation of the heart and lungs. Left ventricular ejection fraction (EF) by MRI was 48 ± 16% (range 13 - 76%). The variables associated with a lower LV EF at univariate analysis were the following: dyspnea on ordinary or less-than-ordinary exertion (p < 0.01), orthopnea (p < 0.01), nocturia (p < 0.05), jugular venous distention (p < 0.05), hepatomegaly (p < 0.005), prominent point of maximal impulse (p = 0.01) and mitral systolic murmur (p < 0.005). However, only orthopnea, sweating, mitral systolic murmur and hepatomegaly were independent predictors of a reduced LV function (EF < 45%) at multiple logistic regression (p< 0.001). The combination of above variables was able to correctly classify 81% of the patients and to detect a reduced EF with a sensitivity of 73% and a specificity of 85%. Thus, symptoms and signs still predict LV dysfunction and should be utilized as a first step in the diagnostic process.
2006
File in questo prodotto:
Non ci sono file associati a questo prodotto.
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11570/1901272
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact