Ansa V O, Odigwe C O, Agbulu R O, Odudu-Umoh I, Uhegbu V, Ekripko U
Department of Medicine, Cardiology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria.
Niger J Clin Pract. 2013 Jan-Mar;16(1):82-5. doi: 10.4103/1119-3077.106772.
There has been a decline in the auscultatory and other clinical skills of physicians especially in developed countries. The advent of echocardiography has revolutionized the diagnosis of cardiovascular diseases and made up for the decline in clinical skills.
To assess the sensitivity and specificity of auscultatory and clinical skills in the diagnosis of cardiovascular diseases using echocardiography as the gold standard.
All the adult echocardiographic studies (321) performed over a 1-year period were collated for analysis. The clinical indications of the studies were compared with the final diagnoses by echocardiography. The sensitivity and specificity of the clinical diagnosis of hypertensive heart disease (HHD), rheumatic heart disease (RHD), and the cardiomyopathies were determined.
Of the 244 (76.0%) clinically diagnosed as HHD, 188 (58.6%) were confirmed by echocardiography. For RHD 9 (2.8%) were diagnosed clinically while on echocardiography, 13 (4.1%) were diagnosed. All the 31 (9.7%) cases of dilated cardiomyopathy were confirmed on echocardiography. No case of ischemic heart disease was confirmed. Seventy-one (22.0%) had normal studies. The sensitivity of clinical diagnosis for RHD was low (41.7%) while for HHD and dilated cardiomyopathy, sensitivity was high, 95.7% and 75.0%, respectively. Specificity was high for all three cardiovascular diseases analyzed.
Auscultatory and clinical skills are still sensitive and specific tools in the diagnosis of cardiovascular diseases in developing countries and should be sustained. However, echocardiography is indispensable in the diagnosis of cases with subtle clinical signs and should be made more available and affordable.
尤其是在发达国家，医生的听诊及其他临床技能有所下降。超声心动图的出现彻底改变了心血管疾病的诊断方式，并弥补了临床技能的下降。
以超声心动图作为金标准，评估听诊及临床技能在心血管疾病诊断中的敏感性和特异性。
整理了在1年期间进行的所有成人超声心动图研究（共321项）用于分析。将这些研究的临床指征与超声心动图的最终诊断结果进行比较。确定高血压性心脏病（HHD）、风湿性心脏病（RHD）和心肌病临床诊断的敏感性和特异性。
在临床诊断为HHD的244例（76.0%）患者中，188例（58.6%）经超声心动图证实。对于RHD，临床诊断出9例（2.8%），而超声心动图诊断出13例（4.1%）。所有31例（9.7%）扩张型心肌病病例经超声心动图证实。没有缺血性心脏病病例得到证实。71例（22.0%）检查结果正常。RHD临床诊断的敏感性较低（41.7%），而HHD和扩张型心肌病的敏感性较高，分别为95.7%和75.0%。所分析的三种心血管疾病的特异性均较高。
在发展中国家，听诊及临床技能在心血管疾病诊断中仍是敏感且特异的工具，应予以保留。然而，超声心动图在诊断具有细微临床体征的病例中不可或缺，应使其更易获得且价格更亲民。
