Butman S M, Ewy G A, Standen J R, Kern K B, Hahn E
Department of Internal Medicine, University of Arizona College of Medicine, Tucson.
J Am Coll Cardiol. 1993 Oct;22(4):968-74. doi: 10.1016/0735-1097(93)90405-p.
The aim of this study was to determine the sensitivity, specificity and utility of the cardiovascular examination in predicting cardiac hemodynamics in patients with advanced chronic congestive heart failure.
Although the physical signs of acute left heart failure have been shown to correlate relatively well with cardiac hemodynamics, their reliability in estimating hemodynamics in patients with chronic heart failure has recently been questioned.
We prospectively recorded the history, cardiovascular physical signs present at bedside examination and the hemodynamic measurements obtained at right heart catheterization in 52 patients with chronic congestive heart failure undergoing in-hospital evaluation for possible heart transplantation. In addition, we obtained chest radiographs and multigated nuclear scans for the evaluation of left ventricular function.
Pulmonary rales, a left ventricular third heart sound, jugular venous distension and the abdominojugular test, when positive, indicated higher right heart pressures and lower measures of cardiac performance. The presence of jugular venous distension, at rest or inducible, had the best combination of sensitivity (81%), specificity (80%) and predictive accuracy (81%) for elevation of the pulmonary capillary wedge pressure (> or = 18 mm Hg). Furthermore, in this population sample, the probability of an elevated wedge pressure was 0.86 when either variable was present.
The bedside cardiovascular examination in the patient with chronic heart failure is extremely useful in identifying patients with elevation of right and left heart pressures. Examination for jugular venous distension at rest or by the abdominojugular test is simple and highly sensitive and specific in assessing left heart pressures in these patients.
本研究旨在确定心血管检查在预测晚期慢性充血性心力衰竭患者心脏血流动力学方面的敏感性、特异性和实用性。
尽管急性左心衰竭的体征已被证明与心脏血流动力学有较好的相关性，但最近人们对其在评估慢性心力衰竭患者血流动力学方面的可靠性提出了质疑。
我们前瞻性地记录了52例因可能进行心脏移植而住院评估的慢性充血性心力衰竭患者的病史、床边检查时出现的心血管体征以及右心导管检查获得的血流动力学测量值。此外，我们还获得了胸部X线片和多门控核素扫描以评估左心室功能。
肺部啰音、左心室第三心音、颈静脉怒张和腹颈静脉回流征阳性时，提示右心压力较高且心脏功能指标较低。颈静脉怒张（静息时或诱发时）的存在，对于肺毛细血管楔压升高（≥18 mmHg）具有最佳的敏感性（81%）、特异性（80%）和预测准确性（81%）组合。此外，在这个人群样本中，当任一变量存在时，楔压升高的概率为0.86。
慢性心力衰竭患者的床边心血管检查对于识别左右心压力升高的患者非常有用。静息时检查颈静脉怒张或通过腹颈静脉回流征检查在评估这些患者的左心压力方面简单且具有高度的敏感性和特异性。
