Value of the electrocardiogram in identifying heart failure due to left ventricular systolic dysfunction

Fewer than half of patients treated for heart failure by general practitioners have objective evidence of cardiac disease. 1 2 To improve diagnosis and treatment Dargie and McMurray suggested that echocardiography should be performed in all patients suspected of having chronic heart failure. 3 Screening patients before referral for diagnostic investigation may lessen the considerable resource implications of this approach. Electrocardiographic findings Impaired left ventricular systolic function Preserved left ventricular systolic function Total Abnormal 90 169 259 Normal + 6 269 275 Total 96 438 534 Sensitivity 90/96=94%; specificity 269/438=61%; positive predictive value 90/259=35%; negative predictive value 269/275=98%. +Normal or minor abnormality (atrial enlargement, bradycardia, tachycardia, broadening of QRS complex, poor R wave progression, right axis deviation, myocardial ischaemia, first degree atrioventricular block, nonspecific ST-T wave changes).