Regardless of the acuity of new-onset HF, it is prudent to consider the impact of the training, experience, and focus of the chest radiography interpreter. For patients presenting to the emergency department (ED) with supportive clinical and laboratory evidence of HF, the accuracy in identifying HF on chest radiograph can vary from 78% for first-year emergency medicine residents, 85% for emergency medicine attendees, and 95% for radiologists [37]. A radiological score based on the sum of selected signs of congestion on chest radiograph correlates well with both findings on physical examination and lung impedance measurements during periods of sudden onset of HF [38]. Accordingly, in patients presenting to an ED with signs and symptoms of HF, those with sudden onset more likely demonstrate evidence of congestion on chest radiograph than those without sudden onset [39]. However, in ambulatory patients being evaluated in the community for suspected new-onset HF with standardized diagnostic evaluation, including chest radiography and TTE, a combination of 3 items from history plus 6 from physical examination have independent diagnostic value (c-statistic 0.83), increasing when supplemented by N- terminal pro-B-type natriuretic peptide (NT-proBNP) (c-statistic 0.86); chest radiography does not make a significant diagnostic contribution [40]. US Echocardiography Transthoracic Resting and Stress Evaluation of cardiac structure and function for newly suspected or potential HF, with rest-only echocardiography for the assessment of cardiac structure and function can be made accurately to guide therapy. Multicenter studies Suspected New-Onset and Known Nonacute Heart Failure
Suspected New Onset and Known Nonacute Heart Failure. Regardless of the acuity of new-onset HF, it is prudent to consider the impact of the training, experience, and focus of the chest radiography interpreter. For patients presenting to the emergency department (ED) with supportive clinical and laboratory evidence of HF, the accuracy in identifying HF on chest radiograph can vary from 78% for first-year emergency medicine residents, 85% for emergency medicine attendees, and 95% for radiologists [37]. A radiological score based on the sum of selected signs of congestion on chest radiograph correlates well with both findings on physical examination and lung impedance measurements during periods of sudden onset of HF [38]. Accordingly, in patients presenting to an ED with signs and symptoms of HF, those with sudden onset more likely demonstrate evidence of congestion on chest radiograph than those without sudden onset [39]. However, in ambulatory patients being evaluated in the community for suspected new-onset HF with standardized diagnostic evaluation, including chest radiography and TTE, a combination of 3 items from history plus 6 from physical examination have independent diagnostic value (c-statistic 0.83), increasing when supplemented by N- terminal pro-B-type natriuretic peptide (NT-proBNP) (c-statistic 0.86); chest radiography does not make a significant diagnostic contribution [40]. US Echocardiography Transthoracic Resting and Stress Evaluation of cardiac structure and function for newly suspected or potential HF, with rest-only echocardiography for the assessment of cardiac structure and function can be made accurately to guide therapy. Multicenter studies Suspected New-Onset and Known Nonacute Heart Failure