Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
J Cardiol. 2010 Mar;55(2):256-65. doi: 10.1016/j.jjcc.2009.11.008. Epub 2010 Jan 14.
Although physicians frequently perform palpation of the apex beat to evaluate left ventricular (LV) size and hypertrophy, the clinical significance of apex beat palpation is still unclear. The introduction of multislice computed tomography (MSCT) has enabled assessment not only of coronary stenoses but also LV volume, mass, and distance from heart to chest wall. The aim of this study was to evaluate the relationships among presence, location, and sustained or double apical impulse of apex beat and LV function, volume, mass, and distance from heart to chest wall determined by MSCT.
The study population consisted of 200 consecutive patients clinically indicated for MSCT angiography for coronary artery evaluation. Apex palpation was performed with the patients in the supine and left lateral decubitus positions. Multivariate analysis revealed that LV mass index (p<0.01), distance (p<0.005), and being male (p<0.005) remained independent factors associated with presence of apex beat in the supine position, and that LV mass index was also associated with location of apex beat. Furthermore, in patients with a palpable apex beat, LV mass index was an independent factor associated with patterns of sustained or double apical impulse. In the group of all patients, patterns of sustained or double apical impulse in the supine position had a sensitivity of 57%, specificity of 90%, positive predictive value of 68%, and negative predictive value of 85% as an indicator of LV hypertrophy.
Palpation of the apex beat is a sensitive diagnostic maneuver for excluding patients with increased LV mass. We believe that our observations have important implications for bedside clinical examination.
尽管医生经常通过触诊心尖搏动来评估左心室（LV）的大小和肥厚程度，但触诊心尖搏动的临床意义仍不清楚。多层螺旋 CT（MSCT）的引入不仅可以评估冠状动脉狭窄，还可以评估 LV 容积、质量以及心脏与胸壁的距离。本研究旨在评估心尖搏动的存在、位置以及持续或双重心尖搏动与 MSCT 确定的 LV 功能、容积、质量和心脏与胸壁距离之间的关系。
本研究人群包括 200 例连续临床需要进行 MSCT 血管造影以评估冠状动脉的患者。在心尖搏动触诊时，患者取仰卧位和左侧卧位。多变量分析显示，LV 质量指数（p<0.01）、距离（p<0.005）和男性（p<0.005）是仰卧位下心尖搏动存在的独立相关因素，而 LV 质量指数也与心尖搏动的位置相关。此外，在可触及心尖搏动的患者中，LV 质量指数是持续或双重心尖搏动模式的独立相关因素。在所有患者中，仰卧位持续或双重心尖搏动模式作为 LV 肥厚的指标，具有 57%的敏感性、90%的特异性、68%的阳性预测值和 85%的阴性预测值。
触诊心尖搏动是排除 LV 质量增加患者的一种敏感诊断方法。我们认为我们的观察结果对床边临床检查具有重要意义。
