Hershman W Y, Moskowitz M A, Marton K I, Balady G J
Evans Memorial Department of Clinical Research, University Hospital, Boston, Massachusetts 02118.
Am J Med. 1989 Oct;87(4):371-6. doi: 10.1016/s0002-9343(89)80816-2.
Echocardiography has become a widely utilized test since its introduction into clinical medicine in the early 1970s. Although it has frequently been performed in patients suspected of having mitral valve prolapse (MVP), its usefulness in this setting has not been systematically studied. To investigate the use and value of echocardiography in patients suspected of having MVP, we conducted a prospective study in which physicians were interviewed before and after ordering echocardiographic testing for patients in whom there was a suspicion of MVP.
The study population included consecutive patients referred to the echocardiography laboratory at Boston University Medical Center because of suspected MVP between January 1 and December 31, 1987. Two standardized telephone interviews were conducted with the physician most responsible for ordering the echocardiogram. The following information was obtained during the first interview, which was always conducted before the echocardiogram was performed: patient demographic and clinical data; the reason for ordering the echocardiogram; the physician's most likely clinical diagnosis; the physician's estimate of the likelihood that the patient had MVP; and the physician's proposed management plans. After the referring physician received the echocardiographic results, a second interview was conducted to determine changes in the most likely clinical diagnosis and management plans. The impact of the echocardiogram on diagnosis and management was evaluated by comparing physician responses before and after reception of echocardiographic results. Receiver operating characteristic (ROC) curves were constructed to assess the physician's skills at distinguishing patients with echocardiographic-documented MVP from those without MVP.
A total of 106 echocardiograms were ordered by 45 different physicians. More than 80% of all echocardiograms were ordered to address diagnostic or therapeutic concerns. On echocardiography, 47 (44%) patients were found to have MVP, six (6%) had mitral regurgitation without prolapse, and 53 (50%) had normal results. On the basis of the ROC curve analysis, the physician's ability to discriminate between patients with and without echocardiographic MVP varied significantly by physician specialty and practice setting. The echocardiographic results led to a change in diagnosis in 59 (56%) patients. A change in management occurred in 29 (27%) patients, with 25 of these 29 changes (86%) related to the initiation or discontinuation of antibiotics.
Echocardiography frequently alters diagnostic assessments and leads to therapeutic changes in some patients suspected of having MVP. However, the benefits of such changes have not yet been demonstrated.
自20世纪70年代初超声心动图被引入临床医学以来，它已成为一项广泛应用的检查。尽管它经常用于疑似二尖瓣脱垂（MVP）的患者，但在这种情况下其效用尚未得到系统研究。为了调查超声心动图在疑似MVP患者中的应用及价值，我们进行了一项前瞻性研究，在为疑似MVP的患者开具超声心动图检查前后对医生进行访谈。
研究人群包括1987年1月1日至12月31日期间因疑似MVP被转诊至波士顿大学医学中心超声心动图实验室的连续患者。对负责开具超声心动图检查单的医生进行了两次标准化电话访谈。在第一次访谈（总是在进行超声心动图检查之前进行）中获取了以下信息：患者的人口统计学和临床数据；开具超声心动图检查的原因；医生最可能的临床诊断；医生对患者患有MVP可能性的估计；以及医生提议的管理计划。在转诊医生收到超声心动图结果后，进行了第二次访谈以确定最可能的临床诊断和管理计划的变化。通过比较医生在收到超声心动图结果前后的回答来评估超声心动图对诊断和管理的影响。构建了受试者操作特征（ROC）曲线以评估医生区分超声心动图证实有MVP的患者和无MVP患者的能力。
45位不同的医生共开具了106份超声心动图检查单。超过80%的超声心动图检查是为了解决诊断或治疗方面的问题。在超声心动图检查中，发现47例（44%）患者有MVP，6例（6%）有二尖瓣反流但无脱垂，53例（50%）结果正常。根据ROC曲线分析，医生区分有和没有超声心动图证实的MVP患者的能力因医生专业和执业环境而异。超声心动图结果导致59例（56%）患者的诊断发生改变。29例（27%）患者的管理发生了变化，这29例变化中有25例（86%）与抗生素的启用或停用有关。
超声心动图经常会改变诊断评估，并导致一些疑似MVP患者的治疗发生变化。然而，这些变化的益处尚未得到证实。
