Detection of left ventricular dysfunction after acute myocardial infarction: comparison of clinical, echocardiographic, and neurohormonal methods.

A M Choy, D Darbar, C C Lang, T H Pringle, G P McNeill, N S Kennedy, A D Struthers

Department of Cardiology, Ninewells Hospital and Medical School, Dundee.

OBJECTIVE--The SAVE study showed that captopril improves mortality in patients with left ventricular dysfunction after myocardial infarction and that this benefit occurred even in patients with no clinically overt heart failure. On the basis of this, it seems important to identify correctly which patients have left ventricular dysfunction after a myocardial infarction. The objective was to compare various methods of identifying patients with left ventricular dysfunction (left ventricular ejection fraction, LVEF, < or = 40%) after acute myocardial infarction. The methods compared were echocardiography (quantitative and qualitative visual assessment), clinical evaluation (subjective assessment and three clinical score methods), and measurement of plasma concentrations of cardiac natriuretic peptide hormones (atrial and brain natriuretic peptides, ANP and BNP). DESIGN--Cross sectional study of left ventricular function in patients two to eight days after acute myocardial infarction. SETTING--Coronary care unit of a teaching hospital. PATIENTS--75 survivors of a recent myocardial infarction aged 40 to 88 with no history of cardiac failure and without cardiogenic shock at the time of entry to the study. MAIN OUTCOME MEASURES--Sensitivities and specificities of the various methods of detecting left ventricular dysfunction were calculated by comparing them with a cross sectional echocardiographic algorithm for LVEF. RESULTS--Clinical impression was poor at identifying LVEF < 40% (sensitivity 46%). Clinical scoring improved this figure somewhat (modified Peel index sensitivity 64%). Qualitative visual assessment echocardiography was a more sensitive method (sensitivity 82%) for detecting LVEF < 40%. Plasma BNP concentration was also a sensitive measure for detecting left ventricular dysfunction (sensitivity 84%) but plasma ANP concentration was much poorer (sensitivity 64%). CONCLUSION--Left ventricular dysfunction is easily and reliably detected by echocardiographic measurement of LVEF and also by a quick qualitative echocardiographic assessment but is likely to be missed by clinical assessment alone. High concentrations of plasma BNP maybe another useful indicator of left ventricular dysfunction, particularly in hospitals where not all patients can be screened by echocardiography or radionuclide ventriculography after myocardial infarction.

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• McDonagh, T A (2002). Screening for left ventricular dysfunction: a step too far?. Heart 88: ii12-14 [Full Text]  
• Jernberg, T., Stridsberg, M., Venge, P., Lindahl, B. (2002). N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation. J Am Coll Cardiol 40: 437-445 [Abstract] [Full Text]  
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• Takeda, S, Rimington, H, Smeeton, N, Chambers, J (2001). Long axis excursion in aortic stenosis. Heart 86: 52-56 [Abstract] [Full Text]  
• Caruana, L., Petrie, M. C, Davie, A. P, McMurray, J. J V (2000). Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study. BMJ 321: 215-218 [Abstract] [Full Text]  
• COWIE, M. R (2000). BNP: soon to become a routine measure in the care of patients with heart failure?. Heart 83: 617-618 [Full Text]  
• Clark, A. L, Coats, A. J S (2000). Unreliability of cardiothoracic ratio as a marker of left ventricular impairment: comparison with radionuclide ventriculography and echocardiography. Postgrad. Med. J. 76: 289-291 [Abstract] [Full Text]  
• Talwar, S, Squire, I.B, Davies, J.E, Barnett, D.B, Ng, L.L (1999). Plasma N-terminal pro-brain natriuretic peptide and the ECG in the assessment of left-ventricular systolic dysfunction in a high risk population. Eur Heart J 20: 1736-1744 [Abstract]  
• Vasan, R. S., Larson, M. G., Benjamin, E. J., Evans, J. C., Reiss, C. K., Levy, D. (1999). Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: Prevalence and mortality in a population-based cohort. J Am Coll Cardiol 33: 1948-1955 [Abstract] [Full Text]  
• Kelly, R., Struthers, A.D. (1999). Screening for left ventricular systolic dysfunction in patients with stroke, transient ischaemic attacks, and peripheral vascular disease. QJM 92: 295-297 [Full Text]  
• Davie, A. P, McMurray, J. J (1999). ACE inhibitors and heart failure in hospital: any difference between cardiologists and general physicians?. Postgrad. Med. J. 75: 219-221 [Abstract] [Full Text]  
• Cheung, B. M. Y., Kumana, C. R. (1998). Natriuretic Peptides--Relevance in Cardiovascular Disease. JAMA 280: 1983-1984 [Full Text]  
• McClure, S. J, Caruana, L., Davie, A. P, Goldthorp, S., McMurray, J. J V (1998). Cohort study of plasma natriuretic peptides for identifying left ventricular systolic dysfunction in primary care. BMJ 317: 516-519 [Abstract] [Full Text]  
• Murdoch, D. R, Byrne, J., Morton, J. J, McDonagh, T. A, Robb, S. D, Clements, S., Ford, I., McMurray, J. J V, Dargie, H. J (1997). Brain natriuretic peptide is stable in whole blood and can be measured using a simple rapid assay: implications for clinical practice. Heart 78: 594-597 [Abstract] [Full Text]  
• Gamel, A. E., Yonan, N. A., Keevil, B., Warbuton, R., Kakadellis, J., Woodcock, A., Campbell, C. S., Rahman, A. N., Deiraniya, A. K. (1997). Significance of Raised Natriuretic Peptides After Bicaval and Standard Cardiac Transplantation. Ann. Thorac. Surg. 63: 1095-1100 [Abstract] [Full Text]  
• Bonow, R. O. (1996). New Insights Into the Cardiac Natriuretic Peptides. Circulation 93: 1946-1950 [Full Text]  
• Omland, T., Aakvaag, A., Bonarjee, V. V. S., Caidahl, K., Lie, R. T., Nilsen, D. W. T., Sundsfjord, J. A., Dickstein, K. (1996). Plasma Brain Natriuretic Peptide as an Indicator of Left Ventricular Systolic Function and Long-term Survival After Acute Myocardial Infarction : Comparison With Plasma Atrial Natriuretic Peptide and N-Terminal Proatrial Natriuretic Peptide. Circulation 93: 1963-1969 [Abstract] [Full Text]  
• Francis, C M, Caruana, L, Kearney, P, Love, M, Sutherland, G R, Starkey, I R, Shaw, T R D, McMurray, J J V (1995). Open access echocardiography in management of heart failure in the community. BMJ 310: 634-636 [Abstract] [Full Text]