Diagnosing left ventricular dysfunction after myocardial infarction: the Dundee algorithm

Large-scale trials of angiotensin converting enzyme (ACE) inhibitors afteracute myocardial infarction (AMI) suggest that the benefits are greatest inpatients with left ventricular (LV) dysfunction. However, early evaluationof LV function in all patients after AMI by current methods can bedifficult due to a lack of resources and skilled personnel. Thus a clinicalalgorithm that could be used at the bedside to reliably identify patientswith a left ventricular ejection fraction (LVEF) < or = 40% would behelpful as an occasional alternative to echocardiography. We have devisedsuch an algorithm based on the presence of one of: (i) clinical signs ofheart failure; (ii) an index Q-wave anterior myocardial infarction; (iii)lack of thrombolytic therapy when there is a history of two or moreprevious myocardial infarctions and a CK rise > 1000 U/l. We tested thisnew algorithm prospectively in the coronary care units of two hospitals(one UK and one USA). In the UK centre, the sensitivity and specificity ofthe algorithm at identifying patients with a LVEF < or = 40% were 82%and 72%, respectively. In the US centre, the sensitivity of the algorithmwas 91% and the specificity 78% at identifying patients with LVdysfunction. We have validated a simple clinical algorithm which can beused at the bedside for identifying patients who would benefit from an ACEinhibitor after AMI.