对选择疑似心力衰竭门诊患者进行超声心动图检查的不同方法的批判性重新评估。
A critical re-appraisal of different ways of selecting ambulatory patients with suspected heart failure for echocardiography.
作者信息
Jeyaseelan Sanjay, Goudie Barclay M, Pringle Stuart D, Donnan Peter T, Sullivan Frank M, Struthers Allan D
机构信息
Department of Cardiology, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
出版信息
Eur J Heart Fail. 2007 Jan;9(1):55-61. doi: 10.1016/j.ejheart.2006.04.003. Epub 2006 Jul 21.
BACKGROUND
ECG and BNP have been assessed as screening tests for LVSD and heart failure. However, echocardiography also provides information about valvular disease and LVH. We assessed how good these screening tests are in identifying whether the subsequent echocardiogram will have any significant abnormality.
AIMS
To re-appraise the ECG and BNP as screening tests for echocardiography since there are important practical deficiencies in our current knowledge in this area.
METHODS
General practitioners referred suspected heart failure patients for clinical assessment, echocardiography, electrocardiography, and BNP measurement. The accuracy of each screening test and combinations of screening tests were calculated for LVSD, heart failure, valvular disease, and LVH.
RESULTS
The sensitivities of the ECG for LVSD, heart failure, LVH and valvular disease were 97%, 95%, 76%, and 69%, respectively. The corresponding figures for BNP were 86%, 82%, 59%, and 48%, respectively. When patients with atrial fibrillation and murmurs were excluded, the values for ECG were 94%, 87%, 53%, and 55%, while for BNP they were 83%, 73%, 50%, and 32%.
CONCLUSIONS
ECG interpretation and BNP are adequate screening tests to detect LVSD or heart failure but fail to screen for other echocardiographic abnormalities, like valvular disease and LVH. This remains the case even if patients with atrial fibrillation or heart murmurs are excluded on the basis that they require echocardiography anyway.
背景
心电图（ECG）和脑钠肽（BNP）已被评估作为左心室收缩功能障碍（LVSD）和心力衰竭的筛查试验。然而，超声心动图还可提供有关瓣膜疾病和左心室肥厚（LVH）的信息。我们评估了这些筛查试验在识别后续超声心动图是否会有任何显著异常方面的效果如何。
目的
鉴于我们目前在该领域的知识存在重要的实际缺陷，重新评估心电图和脑钠肽作为超声心动图的筛查试验。
方法
全科医生将疑似心力衰竭患者转诊进行临床评估、超声心动图检查、心电图检查和脑钠肽测量。计算每项筛查试验以及筛查试验组合对左心室收缩功能障碍、心力衰竭、瓣膜疾病和左心室肥厚的准确性。
结果
心电图对左心室收缩功能障碍、心力衰竭、左心室肥厚和瓣膜疾病的敏感性分别为97%、95%、76%和69%。脑钠肽的相应数字分别为86%、82%、59%和48%。当排除心房颤动和杂音患者后，心电图的值分别为94%、87%、53%和55%，而脑钠肽的值分别为83%、73%、50%和32%。
结论
心电图解读和脑钠肽是检测左心室收缩功能障碍或心力衰竭的充分筛查试验，但无法筛查其他超声心动图异常，如瓣膜疾病和左心室肥厚。即使基于心房颤动或心脏杂音患者无论如何都需要超声心动图检查而将其排除，情况依然如此。
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