Skip to content

Research at St Andrews

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

Research output: Contribution to journalArticle

DOI

Open Access permissions

Open

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 I2 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.

Close

Details

Original languageEnglish
Article number56
JournalBMC Family Practice
Volume9
DOIs
Publication statusPublished - 23 Oct 2008

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Prevalence and distribution of atherosclerosis in a low- to intermediate-risk population: assessment with whole-body MR angiography

    Lambert, M. A., Weir-McCall, J. R., Salsano, M., Gandy, S. J., Levin, D., Cavin, I., Littleford, R., MacFarlane, J. A., Matthew, S. Z., Nicholas, R. S., Struthers, A. D., Sullivan, F., Henderson, S. A., White, R. D., Belch, J. J. F. & Graeme Houston, J., Jun 2018, In : Radiology. 287, 3, p. 795-804 10 p.

    Research output: Contribution to journalReview article

  2. Development and validation of a path length calculation for carotid–femoral pulse wave velocity measurement. A TASCFORCE, SUMMIT, and Caerphilly collaborative venture

    Weir-McCall, J. R., Brown, L., Summersgill, J., Talarczyk, P., Bonnici-Mallia, M., Chin, S. C., Khan, F., Struthers, A. D., Sullivan, F., Colhoun, H. M., Shore, A. C., Aizawa, K., Groop, L., Nilsson, J., Cockcroft, J. R., McEniery, C. M., Wilkinson, I. B., Ben-Shlomo, Y. & Houston, J. G., May 2018, In : Hypertension. 71, 5, p. 937–945 9 p.

    Research output: Contribution to journalArticle

  3. Systemic arteriosclerosis is associated with left ventricular remodeling but not atherosclerosis: a TASCFORCE study

    Weir-McCall, J. R., Lambert, M., Gandy, S. J., Belch, J. J. F., Cavin, I., Henderson, S. A., Littleford, R., Macfarlane, J. A., Matthew, S. Z., Nicholas, R. S., Struthers, A. D., Sullivan, F., White, R. D. & Houston, J. G., 30 Jan 2018, In : Journal of Cardiovascular Magnetic Resonance. 20, 11 p., 7.

    Research output: Contribution to journalArticle

  4. No association between systemic arteriosclerosis and atherosclerosis on cardiac MRI and whole body MR angiography: the TASCFORCE study

    Weir-McCall, J., Lambert, M., Belch, J., Cavin, I., Gandy, S., Littleford, R., Macfarlane, J., Matthew, S., Nicholas, R. S., Struthers, A. D., Sullivan, F., Henderson, S., White, R. & Houston, J. G., 18 May 2017, In : Heart. 103, Suppl 4, p. A5-A6 15.

    Research output: Contribution to journalAbstract

  5. Reply: the enigma of left ventricular non-compaction

    Weir-McCall, J. R., Yeap, P. M., Papagiorcopulo, C., Fitzgerald, K., Gandy, S. J., Lambert, M., Belch, J. J. F., Cavin, I., Littleford, R., Macfarlane, J. A., Matthew, S. Z., Nicholas, R. S., Struthers, A. D., Sullivan, F., Henderson, S. A., White, R. D. & Houston, J. G., 16 May 2017, In : Journal of the American College of Cardiology. 69, 19, p. 2470-2471 2 p.

    Research output: Contribution to journalLetter

Related by journal

  1. Piloting electronic screening forms in primary care: findings from a mixed methods study to identify patients eligible for low dose CT lung cancer screening

    O’Brien, M. A., Sullivan, F., Carson, A., Siddiqui, R., Syed, S. & Paszat, L., 28 Nov 2017, In : BMC Family Practice. 18, 9 p., 95.

    Research output: Contribution to journalArticle

  2. A systematic review and narrative summary of family-based smoking cessation interventions to help adults quit smoking

    Hubbard, G., Gorely, T., Ozakinci, G., Polson, R. & Forbat, L., 24 Jun 2016, In : BMC Family Practice. 17, 20 p., 73.

    Research output: Contribution to journalArticle

  3. Behavioural health consultants in integrated primary care teams: a model for future care

    Dale, H. & Lee, A., 29 Jul 2016, In : BMC Family Practice. 17, 9 p., 97.

    Research output: Contribution to journalArticle

  4. Challenges of managing people with multimorbidity in today's healthcare systems

    Moffat, K. & Mercer, S. W., 14 Oct 2015, In : BMC Family Practice. 16, 3 p., 129.

    Research output: Contribution to journalArticle

  5. Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis

    Cooper, S-A., McLean, G., Guthrie, B., McConnachie, A., Mercer, S., Sullivan, F. & Morrison, J., 27 Aug 2015, In : BMC Family Practice. 16, 11 p., 110.

    Research output: Contribution to journalArticle

ID: 262874660

Top