I enjoyed reading the excellent article by Marantz and associates1 on whether clinical evaluation is as useful as radionuclide ventriculography in the management of patients with congestive heart failure. I agree completely with their conclusion that the clinical diagnosis of congestive heart failure, based on clinical evaluation and chest roentgenogram, is a valid predictor of mortality and provides information independent of the radionuclide left ventricular ejection fraction in determining prognosis in these patients. In this era of high technology, laboratory studies cannot substitute for a careful clinical assessment. The authors are so correct when they said "Rather, it is the thorough clinician who judiciously orders and interprets tests of cardiac function who can best make an accurate prognosis."1
I would like to make three comments. First, although the title of the article is "Prognosis in Ischemic Heart Disease," the text concerns exclusively congestive heart failure, one of the
Cheng TO. Clinical vs Nuclear Laboratory Diagnosis of Congestive Heart Failure. Arch Intern Med. 1993;153(17):2055–2061. doi:10.1001/archinte.1993.00410170147016
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