Left ventricular dysfunction among elderly patients in general practice

Editor—Morgan et al have shown that left ventricular systolic dysfunction is common in elderly patients in a general practice setting.1 They mention that an optimal method of screening for the condition in general practice is not known and go on to conclude that “targeting individuals for more detailed assessment ... would help detect a substantial proportion of the currently unrecognised left ventricular systolic dysfunction.” Davie et al have shown that left ventricular systolic dysfunction is unlikely to be present if an electrocardiogram is normal or shows only minor abnormalities.2 The electrocardiogram has a sensitivity of 94% and a negative predictive value of 98%, making it invaluable in any general practice screening programme for left ventricular systolic dysfunction.2 Conversely, a major electrocardiographic abnormality usually exists in the presence of left ventricular systolic dysfunction.2 In our opinion, electrocardiography, which is cheap and easily performed, should be incorporated into any general practice screening programme for left ventricular systolic dysfunction. Furthermore, electrocardiographic abnormalities such as left bundle branch block can give rise to paradoxical motion of the interventricular septum and subsequent underestimation of left ventricular systolic function.3,4 This could then lead to an overestimation of the prevalence of heart failure. The presence of an electrocardiogram at the time of echocardiographic reporting would therefore be useful. Plasma measurement of the natriuretic peptides offers an additional tool for the assessment of left ventricular systolic dysfunction.5 The exact role of these peptides in screening programmes for heart failure remains to be more precisely determined.