1 Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, China.
2 Pulmonary and Critical Care Medicine, Pulmonary Vascular Disease Program, Brigham and Women's Hospital, Boston, USA.
Eur J Prev Cardiol. 2017 Jul;24(11):1190-1199. doi: 10.1177/2047487317709605. Epub 2017 May 16.
Background Unexplained dyspnea is a common diagnosis that often results in repeated diagnostic testing and even delayed treatments while a determination of the cause is being investigated. Through a retrospective study, we evaluated the diagnostic efficacy of a multidisciplinary dyspnea evaluation center (MDEC) using invasive cardiopulmonary exercise test to diagnose potential causes of unexplained dyspnea. Methods We reviewed the medical records of all patients referred with unexplained dyspnea to the MDEC between March 2011 and October 2014. We assessed the diagnostic efficacy before and after presentation to the MDEC. Results During the study period a total of 864 patients were referred to the MDEC and, of those, 530 patients underwent further investigation with invasive cardiopulmonary exercise test and constituted the study sample. The median age was 57 (44-68) years, 67.2% were women, and median body mass index was 26.22 (22.78-31.01). A diagnosis was made in 530 patients including: exercise pulmonary arterial hypertension of 88 (16.6%), heart failure with preserved ejection fraction of 94 (17.7%), dysautonomia 112 (21.1%), oxidative myopathy of 130 (24.5%), primary hyperventilation of 43 (8.1%), and other 58 (10.9%). The time from initial presentation to referral was significantly longer than time to diagnosis after referral for non-standardized conventional methods versus diagnosis through MDEC using invasive cardiopulmonary exercise test (511 days (292-1095 days) vs. 27 days (13-53 days), p < 0.0001). In a subgroup analysis, we reviewed that patients referred from cardiovascular clinics were more likely to have a greater number of diagnostic tests performed and, conversely, patients referred from pulmonary clinics were more likely to have a greater number of treatments prescribed before referral to MDEC. Conclusions As a result of this retrospective study, we have evaluated that a multidisciplinary approach that includes invasive cardiopulmonary exercise test dramatically reduces the time to diagnosis compared with traditional treatment and testing methods.
不明原因的呼吸困难是一种常见的诊断，通常会导致反复进行诊断性检查，甚至在确定病因的过程中延误治疗。通过回顾性研究，我们评估了多学科呼吸困难评估中心（MDEC）使用有创心肺运动试验诊断不明原因呼吸困难潜在病因的诊断效果。
我们回顾了 2011 年 3 月至 2014 年 10 月期间因不明原因呼吸困难转诊至 MDEC 的所有患者的病历。我们评估了在转诊至 MDEC 前后的诊断效果。
在研究期间，共有 864 名患者转诊至 MDEC，其中 530 名患者接受了进一步的有创心肺运动试验检查，并构成了研究样本。患者的中位年龄为 57（44-68）岁，67.2%为女性，中位体重指数为 26.22（22.78-31.01）。在 530 名患者中做出了以下诊断：运动性肺动脉高压 88 例（16.6%），射血分数保留的心力衰竭 94 例（17.7%），自主神经功能障碍 112 例（21.1%），氧化型肌病 130 例（24.5%），原发性过度通气 43 例（8.1%），其他 58 例（10.9%）。从初次就诊到转诊的时间明显长于从非标准常规方法转诊到 MDEC 后使用有创心肺运动试验的诊断时间（511 天（292-1095 天）与 27 天（13-53 天），p<0.0001）。在亚组分析中，我们发现从心血管诊所转诊的患者更有可能进行更多的诊断性检查，相反，从呼吸科诊所转诊的患者在转诊至 MDEC 之前更有可能接受更多的治疗。
由于这项回顾性研究，我们评估了一种多学科方法，包括有创心肺运动试验，与传统的治疗和检测方法相比，大大缩短了诊断时间。
