Slater J, Gindea A J, Freedberg R S, Chinitz L A, Tunick P A, Rosenzweig B P, Winer H E, Goldfarb A, Perez J L, Glassman E
Department of Medicine, New York University Medical Center, New York.
J Am Coll Cardiol. 1991 Apr;17(5):1026-36. doi: 10.1016/0735-1097(91)90825-t.
Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data.
在患有单纯性或合并性主动脉瓣和二尖瓣疾病的成年患者中，对利用多普勒超声心动图或心导管检查数据做出的临床决策进行了比较。经验丰富的心脏病专家根据多普勒超声心动图或心导管检查数据，做出手术、不手术或仍不确定的临床决策。对189例连续的瓣膜性心脏病患者（平均年龄67岁）进行了前瞻性评估，这些患者基于临床信息正考虑接受手术治疗。所有患者均接受了心导管检查和详细的多普勒超声心动图检查。三组由两名不知道患者身份的心脏病专家组成的决策小组，分别获得了结合多普勒超声心动图或心导管检查数据的临床信息。在21%的主动脉瓣疾病患者和5%的二尖瓣疾病患者中，多普勒超声心动图和临床数据的组合被认为不足以用于临床决策。在2%的主动脉瓣疾病患者和2%的二尖瓣疾病患者中，心导管检查和临床数据的组合被认为不充分。在其余患者中，使用超声心动图或血管造影数据的心脏病专家在手术或不手术的决策上达成一致的有113例（总体为76%）。当按特定瓣膜病变分析数据时，基于多普勒超声心动图或心导管检查的决策在主动脉瓣反流、二尖瓣狭窄、主动脉瓣狭窄和二尖瓣反流患者中分别有92%、90%、83%和69%达成一致。心输出量测定的差异、瓣膜反流的估计以及有关冠状动脉解剖结构的信息是导致不同临床管理决策的主要原因。这些结果表明，对于大多数患有主动脉瓣或二尖瓣疾病（单独或合并）的成年患者，多普勒超声心动图数据能使临床医生做出与心导管检查数据相同的决策。
