Clinical Diagnosis of Congestive Heart Failure in Patients with Acute Dyspnea: Results (Part 2)

The response to the various physical examination maneuvers was compared with the clinical diagnosis of congestive heart failure, both by criteria (Table 3) and by the emergency room physician (Table 4). The hepatojugular reflux test was usually evaluable (assessed in 48, or 94 percent), but was rarely present (positive in six, or 13 percent). Conversely; the Valsalva maneuver was often uninterpretable (assessed in 32, or 63 percent), but was more likely to be abnormal if assessed (positive in 17, or 53 percent). Both the Valsalva maneuver and the hepatojugular response were significantly associated with the diagnosis of congestive heart failure by criteria, as was the hepatojugular response with the emergency room diagnosis (all p<0.05); the association between the Valsalva maneuver and the emergency room diagnosis was not statistically significant (p = 0.087). The Valsalva maneuver was a relatively sensitive indicator of congestive heart failure by criteria or by emergency room diagnosis (0.73 and 0.78, respectively), but was not very specific (0.65 and 0.57, respectively). The presence of hepatojugular reflux was a very insensitive indicator of congestive heart failure by criteria or by the emergency room physician (0.24 and 0.33, respectively), but was quite specific (0.96 and 0.94, respectively). buy ampicillin

Table 3—Physical Manetwers and Diagnosis of CHF by Criteria*

CHF

No CHF

Total

IIJR

Total

{+ –

5

16

21

1

26

27

6

42

SENS = 0.24 SPEC = 0.96 PPV = 0.83 p = 0.049

Valsalva

Total

{+ –

11

4

15

6

11

17

17

15

SENS = 0.73 SPEC = 0.65 PPV = 0.65 > p = 0.0,35

*ER, emergency room; CHF, congestive heart failure; HJR, hepatojugular reflux; SFNS, sensitivity; SPEC, specificity; PPV’, positive predictive value
Table 4—Physical Maneuvers and ER Diagnosis of CHF*

ER Diagnosis

CHF

No CHF

Total

HJR

Total

{+ –

4

8

12

2

34

36

6

42

SENS = 0.33 SPEC = 0.94 PPV = 0.67 . p = 0.028

Valsalva

Total

{+ –

7

2

9

10

13

23

17

15

SENS = 0.78 SPEC = 0.57 PPV = 0.41 . p = 0.087

*ER, emergency room; CHF, congestive heart failure; HJR, hepatojugular reflux; SENS, sensitivity; SPEC, specificity; PPV, positive predictive value

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