Validez de los criterios clínicos de Framingham para el diagnóstico de insuficiencia cardíaca sistólica / Validity of the Framingham clinical criteria in the diagnosis of systolic heart failure

Fundamento. Conocer la validez y utilidad clínica de los criterios de Framingham (CCF) para el diagnóstico de insuficiencia cardíaca (IC) sistólica. Métodos. Estudio descriptivo y transversal. La población de estudio la formaron los pacientes que acudían al Servicio de Urgencias del Hospital de Elche (Alicante) con disnea de origen cardiológico. El método usado fue un estudio de validación en el que se enfrentaba como método de certeza el valor de 0,45 de la fracción de eyección del ventrículo izquierdo (FEVI), con la presencia o ausencia de los CCF. Los indicadores calculados fueron: sensibilidad (S), especificidad (E), valor preditivo positivo (VPP), valor preditivo negativo (VPN) y los cocientes de probabilidad positivo (CPP) y negativo (CPN). Resultados. Se incluyeron 224 pacientes. Los criterios mayores más frecuentes fueron: estertores pulmonares (93%), cardiomegalia (85,9%) y disnea paroxística nocturna u ortopnea (75,8%). Entre los criterios menores destacaron: disnea de esfuerzo (89,2%), derrame pleural (82,8%) y edemas de miembros inferiores (70,1%). Los valores considerados como disfunción sistólica (FEVI 0,45) obtuvieron una buena S y VPN (96,4% y 97% respectivamente). Los indicadores de utilidad clínica demostraron un CPP de 1,52 y un CPN de 0,09. Conclusiones. Los CCF presentan una excelente S, pero escasa E. La negatividad de los CCF excluye el diagnóstico de forma concluyente en el valor de la FEVI de 0,45 (categoría A), pero su presencia no lo confirma debido al gran número de falsos positivos (categoría D)

Background. To assess validity and clinical usefulness of the Framingham clinical criteria for the diagnosis of systolic heart failure. Methods. A descriptive, cross-sectional trial. The study population was made up of the patients who went to the Emergency Department at the Hospital de Elche, Elche, Spain, with cardiac dyspnoea. The method applied was a validation study in which a value of 0.45 of the left ventricular ejection fraction was taken as a sign of certitude and compared to the presence/absence of the Framingham clinical criteria. The study indicators were: sensitivity, specificity, positive predictive value, negative predictive value, positive probability quotient and negative probability quotient. Results. The trial included 224 patients. The most frequent major criteria were: lung rales (93%), megalocardia (85.9%) and paroxysmal nocturnal dyspnoea or orthopnea (75.8%). The most important minor criteria were: exertional dyspnoea (89.2%), pleural effusion (82.8%) and lower limb oedemas (70.1%). The values that were considered as a sign of left ventricular systolic failure (0.45) proved to have good sensitivity and positive predictive value (96.4% and 97%, respectively). Clinical usefulness indicators obtained a positive probability quotient of 1.52 and a negative predictive value of 0.09. Conclusions. The Framingham clinical criteria have excellent sensitivity but poor specificity. The absence of these criteria totally excludes the diagnosis if the value of the left ventricular ejection fraction is 0.45 (A category) but their presence does not confirm the diagnosis because of the high amount of false-positive findings (D category)

[Validity of Framingham criteria as a clinical test for systolic heart failure]. / Validez de los criterios clínicos de Framingham para el diagnóstico de insuficiencia cardíaca sistólica.

BACKGROUND: To assess validity and clinical usefulness of the Framingham clinical criteria for the diagnosis of systolic heart failure. METHODS: A descriptive cross-sectional trial. The study population was made up of the patients who went to the emergency Department at the Hospital de Elche, Elche, Spain, with cardiac dyspnoea. The method applied was a validation study in which a value of 0.45 of the left ventricular ejection fraction was taken as a sign of certitude and compared to the presence/absence of the Framingham clinical criteria. The study indicators were: sensitivity, specificity, positive predictive value, negative predictive value, positive probability quotient and negative probability quotient. RESULTS: The trial included 224 patients. The most frequent major criteria were: lung rales (93%), megalocardia (85.9%) and paroxysmal nocturnal dyspnoea or orthopnea (75.8%). The most important minor criteria were: exertional dyspnoea (89.2%), pleural effusion (82.8%) and lower limb oedemas (70.1%). The values that were considered as a sign of left ventricular systolic failure (0.45) proved to have good sensitivity and positive predictive value (96.4% and 97%, respectively). Clinical usefulness indicators obtained a positive probability quotient of 1.52 and a negative predictive value of 0.09. CONCLUSIONS: The Framingham clinical criteria have excellent sensitivity but poor specificity. The absence of these criteria totally excludes the diagnosis if the value of the left ventricular ejection fraction is 0.45 (A category) but their presence does not confirm the diagnosis because of the high amount of false-positive findings (D category).

Mujer de 74 años con fiebre y dolor abdominal / A 74-year-old woman with severe abdominal pain

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