Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: In The Rational Clinical Examination article addressing dyspnea and heart failure in the emergency department, Dr Wang and colleagues1 cite a single prospective study of 51 patients presenting to an emergency department with dyspnea, in which the blood pressure response to the Valsalva maneuver was recorded and compared with the left ventricular ejection fraction estimated by transthoracic echocardiography.2 The 95% confidence intervals of both the positive and negative likelihood ratios in this study contained 1.0, which prompted Wang et al to state that this examination finding “did not appear useful for assessing the likelihood of heart failure in dyspneic patients.”
Schlegel A. Dyspnea and Heart Failure in the Emergency Department. JAMA. 2006;295(10):1122-1123. doi:10.1001/jama.295.10.1122-a