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September 13, 1993

Clinical vs Nuclear Laboratory Diagnosis of Congestive Heart Failure-Reply

Arch Intern Med. 1993;153(17):2061. doi:10.1001/archinte.1993.00410170147017

I appreciate Cheng's thoughtful comments, and would like to respond to his critiques of the title of our article.1 The descriptor ischemic (emphasis added) was used because subjects were selected for inclusion in our study who had ischemic heart disease suspected by the referring physician, since the ejection fraction has its greatest prognostic utility in patients with ischemic heart disease. Not all subjects had congestive heart failure; in fact, only 41% met our criteria for congestive heart failure, which turned out to be an important predictor of increased mortality. The subtitle critiques are correct. The chest roentgenogram was used, which is not a bedside examination; and the nuclear laboratory can do more than measure ejection fraction. I hope that this does not detract from the main point of the article, which is to compare a simple, routine clinical assessment with a more expensive technology currently in widespread use.