Division of Cardiology, Department of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132-2401, USA.
Clin Cardiol. 2010 Mar;33(3):E36-42. doi: 10.1002/clc.20586.
Clinical assessment of diastolic heart sounds is challenging.
We sought to examine whether visual inspection of acoustic cardiographic tracings augments the accuracy of medical students' and physicians' detection of third and fourth heart sounds (S(3), S(4)) compared to auscultation alone.
A total of 90 adults referred for left heart catheterization underwent digital precordial heart sound recordings by computerized acoustic cardiography. Two blinded, experienced readers using a consensus method determined the presence of the S(3)/S(4) on each file. There were 35 subjects from the following 5 groups participating in this study from 1 teaching institution: first-year medical students (n = 5), fourth-year medical students (n = 5), interns (n = 5), medicine residents (n = 5), cardiology fellows (n = 5), and attendings (n = 10). Using a computer module, each subject listened to the heart sounds alone and documented whether an S(3)/S(4) was present. Next, subjects listened to each recording in random order while viewing phonocardiographic tracings, and recorded S(3)/S(4) presence.
An S(3) was present in 21 patients (23%) and an S(4) in 31 patients (34%) by consensus overread in 90 recordings. Baseline accuracy for auscultation of S(3)/S(4) did not change with level of experience. While viewing the acoustic cardiogram, first-year medical students had minimal improvement in S(3) (2%) and S(4) (11%) accuracy. More experienced subjects improved S(3) accuracy by 8% to 18% and S(4) by 15% to 32% (P < .05). Accuracy was superior for S(3) compared to S(4) in all ausculatory groups.
While listening to heart sound recordings, viewing acoustic cardiography increased subjects' accuracy in detecting diastolic heart sounds, particularly among more experienced subjects. There was greater improvement for S(4) compared to S(3) detection.
对舒张期心音的临床评估具有挑战性。
我们试图研究与单纯听诊相比，通过声学心电图描记图的目视检查是否能提高医学生和医生对第三和第四心音（S3、S4）的检测准确性。
共有 90 名因左心导管检查而接受计算机声学心电图记录的成年人参与了这项研究。两名经验丰富的盲法读者使用共识方法确定每个文件中是否存在 S3/S4。这项研究来自 1 所教学机构的以下 5 个组的 35 名参与者：一年级医学生（n=5）、四年级医学生（n=5）、实习医生（n=5）、内科住院医师（n=5）、心脏病学研究员（n=5）和主治医生（n=10）。每位参与者使用计算机模块单独聆听心音，并记录是否存在 S3/S4。然后，参与者按照随机顺序聆听每个录音，同时观看心音描记图，并记录 S3/S4 的存在。
在 90 次记录中，通过共识重读，21 名患者（23%）存在 S3，31 名患者（34%）存在 S4。听诊 S3/S4 的基线准确性不因经验水平而改变。在观看心电图时，一年级医学生的 S3 准确性仅略有提高（2%），S4 准确性略有提高（11%）。更有经验的受试者提高了 S3 准确性 8%至 18%，S4 准确性提高了 15%至 32%（P<.05）。在所有听诊组中，S3 的准确性均优于 S4。
在聆听心音记录时，观看声学心电图可提高受试者检测舒张期心音的准确性，特别是在经验更丰富的受试者中。S4 的检测改善程度大于 S3。
