University of Ottawa Heart Institute, Ottawa, Ontario, Canada (J.A.M., R.J., T.S.).
University of Ottawa Heart Institute, Ottawa, Ontario, Canada, and King Saud University, Riyadh, Saudi Arabia (A.A.).
Ann Intern Med. 2019 Aug 20;171(4):264-272. doi: 10.7326/M19-1337. Epub 2019 Aug 6.
Incorporating focused cardiac ultrasonography (FoCUS) into clinical examination could improve the diagnostic yield of bedside patient evaluation.
To compare the accuracy of FoCUS-assisted clinical assessment versus clinical assessment alone for diagnosing left ventricular dysfunction or valvular disease in adults having cardiovascular evaluation.
English-language searches of MEDLINE, Embase, and Web of Science from 1 January 1990 to 23 May 2019 and review of reference citations.
Eligible studies were done in patients having cardiovascular evaluation; compared FoCUS-assisted clinical assessment versus clinical assessment alone for the diagnosis of left ventricular systolic dysfunction, aortic or mitral valve disease, or pericardial effusion; and used transthoracic echocardiography as the reference standard.
Three study investigators independently abstracted data and assessed study quality.
Nine studies were included in the meta-analysis. The sensitivity of clinical assessment for diagnosing left ventricular dysfunction (left ventricular ejection fraction <50%) was 43% (95% CI, 33% to 54%), whereas that of FoCUS-assisted examination was 84% (CI, 74% to 91%). The specificity of clinical assessment was 81% (CI, 65% to 90%), and that of FoCUS-assisted examination was 89% (CI, 85% to 91%). The sensitivities of clinical assessment and FoCUS-assisted examination for diagnosing aortic or mitral valve disease (of at least moderate severity) were 46% (CI, 35% to 58%) and 71% (CI, 63% to 79%), respectively. Both the clinical assessment and the FoCUS-assisted examination had a specificity of 94% (CI, 91% to 96%).
Evidence was scant, persons doing ultrasonography had variable skill levels, and most studies had unclear or high risk of bias.
Clinical examination assisted by FoCUS has greater sensitivity, but not greater specificity, than clinical assessment alone for identifying left ventricular dysfunction and aortic or mitral valve disease; FoCUS-assisted examination may help rule out cardiovascular pathology in some patients, but it may not be sufficient for definitive confirmation of cardiovascular disease suspected on physical examination.
None. (PROSPERO: CRD42019124318).
将焦点心脏超声（FoCUS）纳入临床检查可提高床边患者评估的诊断效果。
比较 FoCUS 辅助临床评估与单独临床评估对心血管评估成人左心室功能障碍或瓣膜疾病的诊断准确性。
1990 年 1 月 1 日至 2019 年 5 月 23 日，英文检索 MEDLINE、Embase 和 Web of Science，并查阅参考文献。
入选研究为心血管评估患者，比较 FoCUS 辅助临床评估与单独临床评估对左心室收缩功能障碍、主动脉瓣或二尖瓣疾病或心包积液的诊断，以经胸超声心动图为参考标准。
3 位研究者独立提取数据并评估研究质量。
9 项研究纳入荟萃分析。临床评估诊断左心室功能障碍（左心室射血分数＜50%）的敏感性为 43%（95%CI，33%至 54%），而 FoCUS 辅助检查的敏感性为 84%（95%CI，74%至 91%）。临床评估的特异性为 81%（95%CI，65%至 90%），FoCUS 辅助检查的特异性为 89%（95%CI，85%至 91%）。临床评估和 FoCUS 辅助检查诊断主动脉瓣或二尖瓣疾病（至少为中度严重程度）的敏感性分别为 46%（95%CI，35%至 58%）和 71%（95%CI，63%至 79%）。临床评估和 FoCUS 辅助检查的特异性均为 94%（95%CI，91%至 96%）。
证据有限，行超声检查的人员技能水平参差不齐，大多数研究存在结果偏倚或高偏倚风险。
FoCUS 辅助临床检查在识别左心室功能障碍和主动脉瓣或二尖瓣疾病方面的敏感性高于单独临床检查，但特异性无差异；FoCUS 辅助检查可能有助于排除一些患者的心血管病理，但可能不足以明确证实体格检查怀疑的心血管疾病。
无。（PROSPERO：CRD42019124318）。
