Goldman L, Hashimoto B, Cook E F, Loscalzo A
Circulation. 1981 Dec;64(6):1227-34. doi: 10.1161/01.cir.64.6.1227.
Reproducibility and validity are prerequisites for a useful clinical scale. We therefore prospectively tested the reproducibility and validity of the New York Heart Association criteria and the Canadian Cardiovascular Society criteria for the assessment of cardiac functional class and compared these criteria with a new Specific Activity Scale based on the metabolic costs of specific activities. The New York Heart Association estimates made by two physicians had a reproducibility of only 56%, and only 51% of the estimates agreed with treadmill exercise performance. Functional estimates based on the Canadian Cardiovascular Society criteria were significantly more reproducible (73%), but not significantly more valid. The Specific Activity Scale was as reproducible as the Canadian Cardiovascular Society criteria, and its 68% validity was significantly higher than the validities of the other systems. The easily administered Specific Activity Scale was equally reproducible and valid when used by a nonphysician. It was especially better than the other systems for the evaluation of true class II patients and was significantly less likely to underestimate treadmill performance. Although no set of questions can perfectly predict exercise tolerance, the Specific Activity Scale deserves wider prospective testing.
可重复性和有效性是实用临床量表的前提条件。因此，我们前瞻性地测试了纽约心脏协会标准和加拿大心血管学会标准在评估心功能分级方面的可重复性和有效性，并将这些标准与基于特定活动代谢成本的新的特定活动量表进行了比较。两位医生做出的纽约心脏协会评估的可重复性仅为56%，且只有51%的评估结果与跑步机运动表现相符。基于加拿大心血管学会标准的功能评估具有显著更高的可重复性（73%），但有效性并无显著提高。特定活动量表与加拿大心血管学会标准具有相同的可重复性，其68%的有效性显著高于其他系统。由非医生使用时，易于管理的特定活动量表具有同等的可重复性和有效性。在评估真正的II级患者时，它尤其优于其他系统，并且显著不太可能低估跑步机运动表现。尽管没有一组问题能够完美预测运动耐量，但特定活动量表值得进行更广泛的前瞻性测试。
