Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA.
Am J Cardiol. 2011 Aug 15;108(4):586-90. doi: 10.1016/j.amjcard.2011.03.091. Epub 2011 Jun 9.
Although taking a "quick look" at the heart using a small ultrasound device is now feasible, a formal ultrasound imaging protocol to augment the bedside physical examination has not been developed. Therefore, we sought to evaluate the diagnostic accuracy and prognostic value of a cardiopulmonary limited ultrasound examination (CLUE) using 4 simplified diagnostic criteria that would screen for left ventricular dysfunction (LV), left atrial (LA) enlargement, inferior vena cava plethora (IVC+), and ultrasound lung comet-tail artifacts (ULC+) in patients referred for echocardiography. The CLUE was tested by interpretation of only the parasternal LV long-axis, subcostal IVC, and 2 lung apical views in each of 1,016 consecutive echocardiograms performed with apical lung imaging. For inpatients, univariate and multivariate logistic regression analyses were performed to assess the relations between mortality, CLUE findings, age, and gender. In this echocardiographic referral series, 78% (n = 792) were inpatient and 22% (n = 224) were outpatient. The CLUE criteria demonstrated a sensitivity, specificity, and accuracy for a LV ejection fraction of ≤40% of 69%, 91%, and 89% and for LA enlargement of 75%, 72%, and 73%, respectively. CLUE findings of LV dysfunction, LA enlargement, IVC+, and ULC+ were seen in 16%, 53%, 34%, and 28% of inpatients. The best multivariate logistic model contained 3 predictors of in-hospital mortality: ULC+, IVC+ and male gender, with adjusted odds ratios (95% confidence intervals) of 3.5 (1.4 to 8.8), 5.8 (2.1 to 16.4), and 2.3 (0.9 to 5.8), respectively. In conclusion, a CLUE consisting of 4 quick-look "signs" has reasonable diagnostic accuracy for bedside use and contains prognostic information.
虽然现在可以使用小型超声设备快速观察心脏，但尚未制定正式的超声成像协议来增强床边体检。因此，我们试图评估使用 4 种简化诊断标准进行心肺有限超声检查 (CLUE) 的诊断准确性和预后价值，这些标准可筛查左心室功能障碍 (LV)、左心房 (LA) 扩大、下腔静脉过多 (IVC+) 和超声肺彗星尾伪像 (ULC+)，并对接受超声心动图检查的患者进行筛查。CLUE 通过仅对胸骨旁 LV 长轴、肋下 IVC 和每个肺尖部的 2 个视图进行解释来进行测试，总共对 1016 例进行了肺尖成像的连续超声心动图检查。对于住院患者，进行单变量和多变量逻辑回归分析，以评估死亡率、CLUE 发现、年龄和性别之间的关系。在这个超声心动图转诊系列中，78%（n=792）为住院患者，22%（n=224）为门诊患者。CLUE 标准对左心室射血分数≤40%的敏感性、特异性和准确性分别为 69%、91%和 89%，对 LA 扩大的敏感性、特异性和准确性分别为 75%、72%和 73%。LV 功能障碍、LA 扩大、IVC+和 ULC+的 CLUE 发现分别见于 16%、53%、34%和 28%的住院患者。最佳多变量逻辑模型包含 3 个住院死亡率的预测因子：ULC+、IVC+和男性，调整后的优势比（95%置信区间）分别为 3.5（1.4 至 8.8）、5.8（2.1 至 16.4）和 2.3（0.9 至 5.8）。总之，由 4 个快速观察“迹象”组成的 CLUE 具有合理的床边使用诊断准确性，并包含预后信息。
