title: Clinical Evaluation of Heart Failure: Agreement among Tests.
abstract: Methods commonly used clinically to assess cardiac function in patients with heart failure include ejection fraction (EF), exercise treadmill testing (ETT), and symptom evaluation. Although these approaches are useful in evaluating patients with heart failure, there are at times substantial mismatches between individual assessments. For example, ETT results are often discordant with EF, and patients with minimal symptoms sometimes have surprisingly low EFs. To better define the relationship of these methods of assessment, we studied 56 patients with heart failure with reduced EF (HFrEF) who underwent measurement of ETT duration, EF by echocardiography, quantitative symptom evaluation, and LV peak dP/dt (rate of left ventricular pressure development and decline, measured invasively). Correlations were determined among these four tests in order to assess the relationship of EF, ETT, and symptoms against LV peak dP/dt. In addition, we sought to determine whether EF, ETT, and symptoms correlated with each other. Overall, correlations were poor. Only 15 of 63 total correlations (24%) were significant (p < 0.05). EF correlated most closely with LV peak -dP/dt. Linear regression analysis indicated that EF, ETT, and symptoms taken together predicted LV peak dP/dt better than any one measure alone. We conclude that clinical tests used to assess LV function in patients with HFrEF may not be as accurate or correlate as well as expected. All three clinical measures considered together may be the best representation of cardiac function in HFrEF patients currently available.
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, CA, United States of America.|Department of Medicine, VA San Diego Healthcare System, San Diego, CA, United States of America.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Pandey
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, CA, United States of America.|Department of Medicine, VA San Diego Healthcare System, San Diego, CA, United States of America.
authors.forename: William F
authors.initials: WF
authors.lastname: Penny
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, CA, United States of America.|Department of Medicine, VA San Diego Healthcare System, San Diego, CA, United States of America.
authors.forename: Valmik
authors.initials: V
authors.lastname: Bhargava
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, CA, United States of America.|Department of Medicine, VA San Diego Healthcare System, San Diego, CA, United States of America.
authors.forename: N Chin
authors.initials: NC
authors.lastname: Lai
authors.affiliation: Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, United States of America.|Department of Mathematics, University of California San Diego, San Diego, CA, United States of America.
authors.forename: Ronghui
authors.initials: R
authors.lastname: Xu
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, CA, United States of America.|Department of Medicine, VA San Diego Healthcare System, San Diego, CA, United States of America.
authors.forename: H Kirk
authors.initials: HK
authors.lastname: Hammond
mesh_terms: D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume