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Good Positive and Negative Likelihood Ratios

Good Negative Likelihood Ratio

Good Positive Likelihood Ratio

Negative Findings

Poorly Diagnostic Findings

Findings With Unspecified Accuracy

Congestive Heart Failure: Likelihood Ratios

Introduction: Most of the discussion here refers to decreased LV systolic function. Some studies evaluated symptomatic - or decompensated - heart failure, while others included asymptomatic patients.

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Tags: Cardiac Problem Tag this Diagnosis.

The likelihood ratios of findings for Congestive Heart Failure are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding +LR-LR Comments, Study
ECG
Duplicate Edit
3.20

for patients presenting to ED with dyspnea. Standard is decreased LV systolic function.

Study: BMJ. 1997 Mar 29;314(7085):936-40. PMID 9099117

pro BNP Edit 3.80.1

For pts presenting with dyspnea not due to tamponade, trauma, AMI, ARF. BNP cutoff of 100pg/mL.

Study: NEJM. 2002 Jul 18;347(3):161-167. PMID 12124404

Chest X-Ray
Duplicate Edit
8.90.3

for patients presenting to ED with dyspnea. Standard is decreased LV systolic function.

Study: BMJ. 1997 Mar 29;314(7085):936-40. PMID 9099117

Clinical diagnosis
Duplicate Edit
4.40.5

"initial judgment"

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Good Negative Likelihood Ratio

Finding +LR-LR Comments, Study
Clinical diagnosis
Duplicate Edit
1.50.4

in patients presenting to the ED with dyspnea. Standard is decreased LV systolic function.

Study: BMJ. 1997 Mar 29;314(7085):936-40. PMID 9099117

Dyspnea on Exertion
Duplicate Edit
1.30.5

dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Good Positive Likelihood Ratio

Finding +LR-LR Comments, Study
S3
Duplicate Edit
130.9

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Abdominojugular Reflux Edit 60.8

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Dyspnea on Exertion
Duplicate Edit
50.9

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

History of MI Edit 4.30.7

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Rather similar results in JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

S3
Duplicate Edit
40.6

by reduced EF

Study: JAMA 2005 May 11;293(18):2238-44. PMID 15886379

Elevated JVP Edit 3.70.9

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Rather similar results in JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

History of Angina Edit 30.6

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Paroxsymal Nocturnal Dyspnea Edit 2.60.7

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Crackles
Duplicate Edit
2.40.7

crackles at the lung bases

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

In a study looking at patients undergoing echo for peripheral edema, crackles had a 24% sensitivity and 98% specificity for a cardiac origin of the edema (Clin Cardiol. 2006 Jan;29(1):31-5. PMID: 16477775).

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Rather similar results in JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Peripheral Edema
Duplicate Edit
2.30.6

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Orthopnea Edit 2.20.6

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Peripheral Edema
Duplicate Edit
20.9

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Negative Findings

Finding +LR-LR Comments, Study
Ascites Edit 0.31

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Poorly Diagnostic Findings

Finding +LR-LR Comments, Study
S4 Edit 1.50.8

for reduced EF

Study: JAMA 2005 May 11;293(18):2238-44. PMID 15886379

Rather similar results in JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Fatigue and Weight Gain Edit 11

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Cough Edit 0.91

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Wheezing Edit 0.51.3

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Findings With Unspecified Accuracy

Finding +LR-LR Comments, Study
Tachycardia Edit No accuracy specified.

Heart Rate > 100

Study: Unknown

Crackles
Duplicate Edit
No accuracy specified.

Study: no study specified.

Pulsus Alternans Edit No accuracy specified.

From UpToDate:

virtually pathognomonic of severe left ventricular failure

characterized by evenly spaced alternating strong and weak peripheral pulses. It is best appreciated by applying light pressure on the peripheral arterial pulse, and can be confirmed by measuring the blood pressure. When the cuff pressure is slowly released, phase I Korotkoff sounds are initially heard only during the alternate strong beats; with further release of cuff pressure, the softer sounds of the weak beat also appear. The degree of pulsus alternans can be quantitated by measuring the difference in systolic pressure between the strong and the weak beat.

Study: Examination of the arterial pulse article in UpToDate

Dyspnea Edit No accuracy specified.

Study: no study specified.

Ankle Swelling Edit No accuracy specified.

Study: no study specified.

Purulent Sputum Edit No accuracy specified.

Study: no study specified.

Chest X-Ray
Duplicate Edit
No accuracy specified.

Study: no study specified.

Chest CT Edit No accuracy specified.

Study: no study specified.

ECG
Duplicate Edit
No accuracy specified.

Study: no study specified.

Arterial Blood Gas Edit No accuracy specified.

Study: no study specified.

Elevated CRP Edit No accuracy specified.

Study: no study specified.

Elevated D-dimer Edit No accuracy specified.

Study: no study specified.