Picano E, Lattanzi F, Orlandini A, Marini C, L'Abbate A
C.N.R. Clinical Physiology Institute, University of Pisa, Italy.
J Am Coll Cardiol. 1991 Mar 1;17(3):666-9. doi: 10.1016/s0735-1097(10)80182-2.
The aim of this study was to evaluate how the diagnostic accuracy of a stress echocardiographic procedure, such as a dipyridamole echocardiography test, depends on the specific experience of the physician interpreting the test. Recordings of 50 consecutive dipyridamole echocardiographic tests were selected for the first part of the study. They were analyzed by 20 experienced echocardiographers with different backgrounds in stress echocardiography: 10 beginners (less than 20 stress studies interpreted with trained staff) and 10 experienced observers (greater than or equal to 100 stress studies performed). Diagnostic accuracy (true positive + true negative/total number of tests) versus the angiographic reference standard (greater than 70% coronary stenosis of at least one major coronary artery) was 62 +/- 6% for beginners and 85 +/- 3% for experienced observers (p less than 0.0001). In the second part of the study, 10 observers (5 beginners and 5 experienced observers) evaluated 2 different sets of 50 dipyridamole echocardiographic test studies before and after the training of the beginners. Before training, the accuracy of beginners was lower than that of experienced observers (61 +/- 7% versus 85 +/- 3%; p less than 0.001). After training, the accuracy gap was closed (83 +/- 3% versus 86 +/- 2%; p = NS). Therefore, interpretation of stress echocardiographic tests by an echocardiographer without specific training severely underestimates the diagnostic potential of this technique. One hundred stress echocardiographic studies are more than adequate to build the individual learning curve and reach the plateau of diagnostic accuracy that the test can yield.
本研究的目的是评估诸如双嘧达莫超声心动图检查等负荷超声心动图检查程序的诊断准确性如何取决于解读检查结果的医生的具体经验。在研究的第一部分，选取了连续50例双嘧达莫超声心动图检查的记录。由20名在负荷超声心动图方面有不同背景的经验丰富的超声心动图医生对其进行分析：10名初学者（在有培训人员指导下解读的负荷研究少于20例）和10名经验丰富的观察者（进行过大于或等于100例负荷研究）。与血管造影参考标准（至少一支主要冠状动脉狭窄大于70%）相比，初学者的诊断准确性（真阳性+真阴性/检查总数）为62±6%，经验丰富的观察者为85±3%（p<0.0001）。在研究的第二部分，10名观察者（5名初学者和5名经验丰富的观察者）在初学者接受培训前后对两组不同的50例双嘧达莫超声心动图检查研究进行了评估。培训前，初学者的准确性低于经验丰富的观察者（61±7%对85±3%；p<0.001）。培训后，准确性差距缩小（83±3%对86±2%；p=无显著差异）。因此，未经专门培训的超声心动图医生对负荷超声心动图检查结果的解读严重低估了该技术的诊断潜力。100例负荷超声心动图研究足以构建个体学习曲线并达到该检查所能产生的诊断准确性平台。
