Davie A P, Francis C M, Caruana L, Sutherland G R, McMurray J J
Department of Cardiology, Western General Hospital, Edinburgh, UK.
QJM. 1997 May;90(5):335-9. doi: 10.1093/qjmed/90.5.335.
We assessed the value of symptoms, past history, medications and signs in the evaluation of patients who might have heart failure secondary to left ventricular systolic dysfunction. An open-access echocardiography service was set up to help identify patients with left ventricular systolic dysfunction who might benefit from treatment with an angiotensin-converting-enzyme inhibitor. History and examination were recorded for each of these patients. The patients were divided into groups according to whether left ventricular systolic function was preserved or not and whether various clinical features were present or not. Of 259 consecutive patients studied, 41 had impairment of left ventricular systolic function as assessed by echocardiography. Past history of myocardial infarction and displaced apex beat were the best single predictors of left ventricular systolic dysfunction as assessed by echocardiography. The combination of past history of myocardial infarction and displaced apex had the best positive predictive value of all. Patients with such clinical features or combinations of clinical features may not need echocardiography, and where access to this resource is limited, it could be reserved for patients without such diagnostic features.
我们评估了症状、既往史、用药情况及体征在评估可能因左心室收缩功能障碍继发心力衰竭患者中的价值。设立了一项开放获取的超声心动图检查服务，以帮助识别可能从血管紧张素转换酶抑制剂治疗中获益的左心室收缩功能障碍患者。记录了这些患者中的每一位的病史和检查情况。根据左心室收缩功能是否保留以及是否存在各种临床特征将患者分组。在连续研究的259例患者中，经超声心动图评估有41例存在左心室收缩功能损害。心肌梗死既往史和心尖搏动移位是经超声心动图评估的左心室收缩功能障碍的最佳单一预测因素。心肌梗死既往史和心尖搏动移位的组合具有所有因素中最佳的阳性预测价值。具有此类临床特征或临床特征组合的患者可能不需要超声心动图检查，而在获取该资源受限的情况下，可将其保留给没有此类诊断特征的患者。
