库斯莫尔征在右心室心肌梗死诊断中的应用：诊断试验准确性研究的系统评价和荟萃分析。

Kussmaul's sign for the diagnosis of right ventricular myocardial infarction: a systematic review and meta-analysis of diagnostic test accuracy studies.

机构信息

Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E2C6, Canada.

Canadian Armed Forces, Ottawa, Canada.

出版信息

CJEM. 2021 Mar;23(2):185-194. doi: 10.1007/s43678-020-00012-8. Epub 2021 Jan 4.

DOI:10.1007/s43678-020-00012-8

PMID:33709353

Abstract

INTRODUCTION

Kussmaul's sign, the absence of a drop in jugular venous pressure or a paradoxical increase in jugular venous pressure on inspiration, can be evaluated as an indicator of right ventricular myocardial infarction. Right ventricular myocardial infarction complicates 30-50% of inferior myocardial infarctions and is associated with increased mortality when compared to inferior myocardial infarction without right ventricular involvement. Early recognition allows maintenance of preload. We reviewed the diagnostic test accuracy studies for Kussmaul's sign for diagnosis of right ventricular myocardial infarction.

METHODS

We conducted a librarian-assisted search using PubMed, Medline, Embase, and the Cochrane database from 1965 to October 2019. Only English language restriction was imposed. We identified studies that assessed patients presenting to a hospital with a suspected myocardial infarction who underwent an assessment for Kussmaul's sign and a diagnostic test for right ventricular myocardial infarction. Four independent reviewers extracted data from relevant studies. Study quality was assessed using the QUADAS-2 tool. A bivariate random effects meta-analysis was performed.

RESULTS

We identified 122 studies; ten were selected for full review. Eight studies had comparable populations with a total of 469 consecutive patients admitted with acute inferior myocardial infarction and were included in the analysis. Prevalence of right ventricular myocardial infarction was 36% (confidence interval [CI] 95% 31.8-40.5). All reference standards were combined. Kussmaul's sign had a sensitivity of 62.5% (44.6, 77.5), specificity 90% (73.0, 96.8), negative likelihood ratio (LR) 0.2 (0.1-0.8) and positive LR 5.8 (2.5, 13.3).

CONCLUSION

In the presence of acute myocardial infarction, Kussmaul's sign is specific for acute right ventricular myocardial infarction and may serve as an important clinical sign of right ventricular dysfunction requiring preload preserving management.

摘要

简介

克氏征（Kussmaul's sign），即吸气时下腔静脉压无下降或反而上升，可作为右心室心肌梗死的一个指标进行评估。右心室心肌梗死可并发于 30-50%的下壁心肌梗死，与无右心室受累的下壁心肌梗死相比，其死亡率更高。早期识别有助于维持前负荷。我们回顾了用于诊断右心室心肌梗死的克氏征诊断试验准确性研究。

方法

我们在 1965 年至 2019 年 10 月期间，通过图书馆员辅助检索了 PubMed、Medline、Embase 和 Cochrane 数据库。仅施加了英语语言限制。我们确定了评估疑似心肌梗死患者的研究，这些患者接受了克氏征评估和右心室心肌梗死的诊断性检查。四名独立的评审员从相关研究中提取数据。使用 QUADAS-2 工具评估研究质量。进行了双变量随机效应荟萃分析。

结果

我们确定了 122 项研究；其中 10 项被选为全面审查。8 项研究具有可比性，共有 469 例连续急性下壁心肌梗死患者纳入分析。右心室心肌梗死的患病率为 36%（95%置信区间[CI] 31.8-40.5）。所有参考标准均合并。克氏征的敏感性为 62.5%（44.6，77.5），特异性为 90%（73.0，96.8），阴性似然比（LR）为 0.2（0.1-0.8），阳性 LR 为 5.8（2.5，13.3）。