Kadle Rohini L, Phoon Colin K L
Division of Pediatric Cardiology, Hassenfeld Children's Hospital of New York at NYU Langone, Fink Children's Center, New York, NY 10016, United States.
World J Cardiol. 2017 Aug 26;9(8):693-701. doi: 10.4330/wjc.v9.i8.693.
To extend our previously-published experience in estimating pressure gradients (PG) physical examination in a large patient cohort.
From January 1, 1997 through December 31, 2009, an attending pediatric cardiologist compared clinical examination (EXAM) with Doppler-echo (ECHO), in 1193 patients with pulmonic stenosis (PS, including tetralogy of Fallot), aortic stenosis (AS), and ventricular septal defect (VSD). EXAM PG estimates were based primarily on a murmur's pitch, grade, and length. ECHO peak instantaneous PG was derived from the modified Bernoulli equation. Patients were 0-38.4 years old (median 4.8).
For all patients, EXAM correlated highly with ECHO: ECHO = 0.99 (EXAM) + 3.2 mmHg; r = +0.89; < 0.0001. Agreement was excellent (mean difference = -2.9 ± 16.1 mmHg). In 78% of all patients, agreement between EXAM and ECHO was within 15 mmHg and within 5 mmHg in 45%. Clinical estimates of PS PG were more accurate than of AS and VSD. A palpable precordial thrill and increasing loudness of the murmur predicted higher gradients ( < 0.0001). Weight did not influence accuracy. A learning curve was evident, such that the most recent quartile of patients showed ECHO = 1.01 (EXAM) + 1.9, r = +0.92, < 0.0001; during this time, the attending pediatric cardiologist had been > 10 years in practice.
Clinical examination can accurately estimate PG in PS, AS, or VSD. Continual correlation of clinical findings with echocardiography can lead to highly accurate diagnostic skills.
在一个大型患者队列中扩展我们之前发表的关于通过体格检查估计压力阶差（PG）的经验。
从1997年1月1日至2009年12月31日，一位儿科心脏病专家对1193例患有肺动脉狭窄（PS，包括法洛四联症）、主动脉狭窄（AS）和室间隔缺损（VSD）的患者进行了临床检查（EXAM）与多普勒超声心动图（ECHO）的比较。EXAM对PG的估计主要基于杂音的音调、分级和时长。ECHO峰值瞬时PG由改良的伯努利方程得出。患者年龄为0至38.4岁（中位数4.8岁）。
对于所有患者，EXAM与ECHO高度相关：ECHO = 0.99（EXAM）+ 3.2 mmHg；r = +0.89；P < 0.0001。一致性极佳（平均差值 = -2.9 ± 16.1 mmHg）。在所有患者中，78%的EXAM与ECHO之间的一致性在15 mmHg以内，45%在5 mmHg以内。PS的PG临床估计比AS和VSD更准确。可触及的心前区震颤和杂音响度增加预示着更高的压力阶差（P < 0.0001）。体重不影响准确性。存在明显的学习曲线，使得最近一组患者显示ECHO = 1.01（EXAM）+ 1.9，r = +0.92，P < 0.0001；在此期间，这位儿科心脏病专家已从业超过10年。
临床检查可准确估计PS、AS或VSD中的PG。临床发现与超声心动图的持续对比可带来高度准确的诊断技能。
