Houghton A R, Sparrow N J, Toms E, Cowley A J
Department of Cardiovascular Medicine, University Hospital, Queen's Medical Centre, Nottingham, UK.
Int J Cardiol. 1997 Oct 31;62(1):31-6. doi: 10.1016/s0167-5273(97)00181-2.
Patient referrals from general practice for suspected heart failure are increasing the demand for echocardiograms, many of which are normal. We investigated whether general practitioners could be more selective by referring only patients with abnormal electrocardiograms for echocardiography. The electrocardiograms of 200 patients attending a heart failure clinic were analysed by a consultant cardiologist and two general practitioners. All three assessors examined the electrocardiograms independently and unaware of the echocardiography results. The correlation between abnormal electrocardiograms and left ventricular systolic dysfunction on echocardiography was assessed, together with the concordance between the assessors in their electrocardiogram interpretations. One hundred and sixty-five patients had echocardiographic evidence of left ventricular systolic dysfunction. When interpreted by a cardiologist, the electrocardiogram had a sensitivity of 89.1% and a specificity of 45.7% in predicting left ventricular systolic dysfunction. The general practitioners' results were comparable to the cardiologist's. We estimate that using the electrocardiogram to select patients could reduce the number of open access echocardiograms performed for suspected heart failure by up to 43% but would miss 10% of those with significant left ventricular systolic dysfunction. We therefore do not recommend selecting patients for open access echocardiography on the basis of electrocardiographic abnormalities.
从普通诊所转诊来怀疑患有心力衰竭的患者，对超声心动图检查的需求不断增加，其中许多检查结果是正常的。我们调查了全科医生是否可以通过仅转诊心电图异常的患者进行超声心动图检查来提高选择的针对性。一位心脏病顾问医生和两位全科医生分析了200名前往心力衰竭诊所就诊患者的心电图。三位评估人员均独立检查心电图，且不知道超声心动图检查结果。评估了心电图异常与超声心动图显示的左心室收缩功能障碍之间的相关性，以及评估人员在心电图解读方面的一致性。165名患者有超声心动图显示左心室收缩功能障碍的证据。由心脏病专家解读时，心电图预测左心室收缩功能障碍的敏感性为89.1%，特异性为45.7%。全科医生的结果与心脏病专家的相当。我们估计，使用心电图来选择患者可以将因怀疑心力衰竭而进行的开放获取超声心动图检查数量减少多达43%，但会遗漏10%有明显左心室收缩功能障碍的患者。因此，我们不建议根据心电图异常来选择患者进行开放获取超声心动图检查。
