Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK.
Department of Cardiology, University of Nicosia Medical School, Nicosia, Cyprus.
Postgrad Med J. 2023 May 22;99(1170):308-312. doi: 10.1136/postgradmedj-2021-141195.
To evaluate the prevalence and incidence of significant structural heart disease in targeted patients with cardiac symptoms referred by general practitioners (GPs) using open access echocardiography, without prior clinical evaluation by a cardiologist.
Data were derived from 488 subjects who underwent transthoracic echocardiography between January and April 2018. Patients were referred directly by GPs in East Berkshire, South England, through an online platform. Echocardiography was performed within 4-6 weeks of referral and all reports were assessed by a consultant cardiologist with expedited follow-up facilitated pro re nata. Results were analysed to determine the frequency of detection of structural abnormalities, particularly of the left ventricle and cardiac valves.
Echocardiography was prospectively performed in consecutive subjects (50% male, mean (±SD) age 68.5±22 years; 50% female; mean (±SD) 64.6 (±19.1)). At least one abnormality likely to change management was found in 133 (27.3%) of all open access echocardiograms. Clinical heart failure with left ventricular systolic dysfunction (LVSD) and diastolic dysfunction was confirmed in 46 (9%) and 69 (14%), respectively. Of the 46 patients with LVSD, 33 were new diagnoses. Significant cardiac valve disease was found in 42 (8.6%) patients. 12 of these had known valvular disease or previous valvular surgery, and 30 were new diagnoses.
Major structural and functional cardiac abnormalities are common in late middle-aged patients who present to GPs with cardiac symptoms and signs. Reported, unrestricted open access echocardiography enables early detection of significant cardiac pathology and timely intervention may improve cardiovascular outcomes.
通过开放获取超声心动图评估由全科医生（GP）转诊的有心脏症状的目标患者中显著结构性心脏病的患病率和发病率，而无需先由心脏病专家进行临床评估。
数据来自于 2018 年 1 月至 4 月间进行经胸超声心动图检查的 488 例患者。患者通过英国东南部伯克郡东部的一个在线平台，直接由全科医生转诊。转诊后 4-6 周内进行超声心动图检查，所有报告均由一名顾问心脏病专家进行评估，并通过快速随访便利适时处理。分析结果以确定结构性异常的检出频率，特别是左心室和心脏瓣膜的异常。
连续对患者进行前瞻性超声心动图检查（50%为男性，平均（±SD）年龄 68.5±22 岁；50%为女性，平均（±SD）年龄 64.6（±19.1）岁）。在所有开放获取超声心动图中，有 133 例（27.3%）至少发现一种可能改变治疗方案的异常。临床心力衰竭伴左心室收缩功能障碍（LVSD）和舒张功能障碍分别在 46 例（9%）和 69 例（14%）中得到确认。在 46 例 LVSD 患者中，33 例为新诊断。42 例（8.6%）患者存在显著心脏瓣膜疾病。其中 12 例患者有已知瓣膜疾病或既往瓣膜手术史，30 例为新诊断。
在出现心脏症状和体征的中老年患者中，常见主要结构性和功能性心脏异常。报告的不受限制的开放获取超声心动图可早期发现显著的心脏病理，并及时干预可能改善心血管结局。
