de Bruyne M C, Kors J A, Hoes A W, Kruijssen D A, Deckers J W, Grosfeld M, van Herpen G, Grobbee D E, van Bemmel J H
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, Netherlands.
J Clin Epidemiol. 1997 Aug;50(8):947-52. doi: 10.1016/s0895-4356(97)00100-5.
We assessed the performance of diagnostic electrocardiogram (ECG) interpretation by the computer program MEANS and by research physicians, compared to cardiologists, in a physician-based study. To establish a strategy for ECG interpretation in health surveys, we also studied the diagnostic capacity of three scenarios: use of the computer program alone (A), computer program and cardiologist (B), and computer program, research physician, and cardiologist (C). A stratified random sample of 381 ECGs was drawn from ECGs collected in the Rotterdam Study (n = 3057), which were interpreted both by a trained research physician using a form for structured clinical evaluation and by MEANS. All ECGs were interpreted independently by two cardiologists; if they disagreed (n = 175) the ECG was judged by a third cardiologist. Five ECG diagnoses were considered: anterior and inferior myocardial infarction (MI), left and right bundle branch block (LBBB and RBBB), and left ventricular hypertrophy (LVH). Overall, sensitivities and specificities of MEANS and the research physicians were high. The sensitivity of MEANS ranged from 73.8% to 92.9% and of the research physician ranged from 71.8% to 96.9%. The specificity of MEANS ranged from 97.5% to 99.8% and of the research physician from 96.3% to 99.6%. To diagnose LVH, LBBB, and RBBB, use of the computer program alone gives satisfactory results. Preferably, all positive findings of anterior and inferior MI by the program should be verified by a cardiologist. We conclude that diagnostic ECG interpretation by computer can be very helpful in population-based research, being at least as good as ECG interpretation by a trained research physician, but much more efficient and therefore less expensive.
在一项基于医生的研究中，我们评估了计算机程序MEANS和研究医师对诊断性心电图（ECG）解读的表现，并与心脏病专家进行了比较。为了制定健康调查中ECG解读的策略，我们还研究了三种方案的诊断能力：单独使用计算机程序（A）、计算机程序与心脏病专家结合（B）以及计算机程序、研究医师与心脏病专家结合（C）。从鹿特丹研究（n = 3057）收集的ECG中抽取了381份ECG的分层随机样本，这些ECG由一名经过培训的研究医师使用结构化临床评估表格进行解读，同时也由MEANS进行解读。所有ECG均由两名心脏病专家独立解读；如果他们意见不一致（n = 175），则由第三名心脏病专家进行判断。考虑了五种ECG诊断：前壁和下壁心肌梗死（MI）、左束支传导阻滞和右束支传导阻滞（LBBB和RBBB）以及左心室肥厚（LVH）。总体而言，MEANS和研究医师的敏感性和特异性都很高。MEANS的敏感性范围为73.8%至92.9%，研究医师的敏感性范围为71.8%至96.9%。MEANS的特异性范围为97.5%至99.8%，研究医师的特异性范围为96.3%至99.6%。为了诊断LVH、LBBB和RBBB，单独使用计算机程序就能得出令人满意的结果。最好，该程序对前壁和下壁MI的所有阳性结果都应由心脏病专家进行核实。我们得出结论，计算机对诊断性ECG的解读在基于人群的研究中非常有帮助，至少与经过培训的研究医师进行的ECG解读一样好，但效率更高，因此成本更低。
