Stevenson L W, Perloff J K
Department of Medicine, UCLA Medical Center 90024.
JAMA. 1989 Feb 10;261(6):884-8.
The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population. We prospectively compared physical signs with hemodynamic measurements in 50 patients with known chronic heart failure (ejection fraction, .18 +/- .06). Rales, edema, and elevated mean jugular venous pressure were absent in 18 of 43 patients with pulmonary capillary wedge pressures greater than or equal to 22 mm Hg, for which the combination of these signs had 58% sensitivity and 100% specificity. Proportional pulse pressure correlated well with cardiac index (r = .82), and when less than 25% pulse pressure had 91% sensitivity and 83% specificity for a cardiac index less than 2.2 L/min/m2. In chronic heart failure, reliance on physical signs for elevated ventricular filling pressure might result in inadequate therapy. Conversely, the adequacy of cardiac output is assessed reliably by pulse pressure. Our results facilitate decisions regarding treatment in chronic heart failure.
心血管体格检查通常被用作慢性心力衰竭诊断和治疗的依据，尽管对于该人群，体征、心室充盈压升高和心输出量降低之间的关系尚未明确。我们前瞻性地比较了50例已知慢性心力衰竭患者（射血分数为0.18±0.06）的体征与血流动力学测量结果。在43例肺毛细血管楔压大于或等于22 mmHg的患者中，有18例没有啰音、水肿和颈静脉平均压升高，这些体征联合出现时的敏感性为58%，特异性为100%。脉压比例与心脏指数相关性良好（r = 0.82），当脉压小于25%时，对于心脏指数小于2.2 L/min/m²的情况，敏感性为91%，特异性为83%。在慢性心力衰竭中，依靠体征判断心室充盈压升高可能导致治疗不足。相反，通过脉压可以可靠地评估心输出量是否充足。我们的结果有助于慢性心力衰竭治疗决策。
