PMID- 21990340
OWN - NLM
STAT- MEDLINE
DCOM- 20120327
LR  - 20161125
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 13
IP  - 12
DP  - 2011 Dec
TI  - Does the physical examination still have a role in patients with suspected heart 
      failure?
PG  - 1340-8
LID - 10.1093/eurjhf/hfr128 [doi]
AB  - AIMS: The prognostic value of signs of congestion in patients suspected of having 
      chronic heart failure (CHF) is unknown. Our objectives were to define their 
      prevalence and specificity in diagnosing CHF and to determine their prognostic 
      value in patients in a community heart failure clinic. METHODS AND RESULTS: 
      Analysis of referrals to a community clinic for patients with CHF symptoms. 
      Systolic CHF (S-HF) was defined as left ventricular ejection fraction (LVEF) 
      </=45%, heart failure with normal ejection fraction (HeFNEF) as LVEF > 45%, and 
      amino-terminal pro-brain natriuretic peptide >50 pmol L(-1); other subjects were 
      defined as not having CHF. Signs of congestion were as follows: no signs; right 
      heart congestion (RHC: oedema, jugular venous distension); left heart congestion 
      (LHC: lung crackles); or both (R + LHC). Of 1881 patients referred, 707 did not 
      have CHF, 853 had S-HF, and 321 had HeFNEF. The median inter-quartile range (IQR) 
      age was 72 years (64-78), 40% were women, and LVEF was 47% (35-59). Overall, 417 
      patients had RHC of whom 49% had S-HF and 21% HeFNEF. Eighty-five patients had 
      LHC of whom 43% had S-HF and 20% had HeFNEF. One hundred and seventy-two patients 
      had R + LHC of whom 71% had S-HF and 16% had HeFNEF. During a median (IQR) 
      follow-up of 64(44-76) months, 40% of the entire patient cohort died. The 
      combination of R + LHC signs was an independent marker of an adverse prognosis 
      (chi(2)-log-rank test = 186.1, P< 0.0001). CONCLUSION: Clinical signs of congestion 
      are independent predictors of prognosis in ambulatory patients with suspected 
      CHF.
FAU - Damy, Thibaud
AU  - Damy T
AD  - Department of Cardiology, University of Hull, Castle Hill Hospital, 
      Kingston-upon-Hull, Cottingham, UK. thibaud.damy@hmn.aphp.fr
FAU - Kallvikbacka-Bennett, Anna
AU  - Kallvikbacka-Bennett A
FAU - Zhang, Jufen
AU  - Zhang J
FAU - Goode, Kevin
AU  - Goode K
FAU - Buga, Laszlo
AU  - Buga L
FAU - Hobkirk, James
AU  - Hobkirk J
FAU - Yassin, Ashraf
AU  - Yassin A
FAU - Dubois-Rande, Jean-Luc
AU  - Dubois-Rande JL
FAU - Hittinger, Luc
AU  - Hittinger L
FAU - Cleland, John G F
AU  - Cleland JG
FAU - Clark, Andrew L
AU  - Clark AL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20111011
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
SB  - IM
MH  - Aged
MH  - Diagnosis, Differential
MH  - Edema/diagnosis/etiology
MH  - Female
MH  - Heart Failure/complications/*diagnosis/epidemiology
MH  - Humans
MH  - Hyperemia/*diagnosis/etiology
MH  - Male
MH  - Middle Aged
MH  - *Physical Examination
MH  - Prevalence
MH  - Prognosis
MH  - Reproducibility of Results
MH  - Severity of Illness Index
MH  - United Kingdom/epidemiology
EDAT- 2011/10/13 06:00
MHDA- 2012/03/28 06:00
CRDT- 2011/10/13 06:00
PHST- 2011/10/13 06:00 [entrez]
PHST- 2011/10/13 06:00 [pubmed]
PHST- 2012/03/28 06:00 [medline]
AID - hfr128 [pii]
AID - 10.1093/eurjhf/hfr128 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2011 Dec;13(12):1340-8. doi: 10.1093/eurjhf/hfr128. Epub 2011 
      Oct 11.