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Interpretation of echocardiographic measurements: A call for standardization

AMERICAN HEART JOURNAL 2000年第3期139卷 412-422页

作者： Vasan, RS Levy, D Larson, MG Benjamin, EJ Framingham Heart Dis Epidemiol Study NHLBI Framingham MA 01702 USA Beth Israel Hosp Div Cardiol Boston MA 02215 USA Beth Israel Hosp Div Clin Epidemiol Boston MA 02215 USA Boston Univ Sch Med Cardiol Sect Boston MA 02215 USA Boston Univ Sch Med Dept Prevent Med Boston MA 02215 USA NHLBI Framingham Heart Study Framingham MA USA

Background Although echocardiography is used extensively in clinical medicine, guidelines for quantitative interpretation of echocardiographic measurements are unavailable. The goals of this investigation were to provide an overview of scientific standards for formulating reference values, with clinical chemistry used as a model, to evaluate published echocardiographic reference limits, to survey clinical echocardiography laboratories regarding their interpretation of echocardiographic measurements, and to provide recommendations for improving the interpretation and reporting of echocardiographic measurements. Methods and Results We reviewed the original reports of the international Federation of Clinical Chemistry on guidelines for formulating reference valves. We obtained published reports on echocardiographic reference limits through searches of electronic databases supplemented by a manual search of relevant bibliographies. We also surveyed echocardiographic laboratories in 35 adult acute-care hospitals in Eastern Massachusetts. Studies on echocardiographic reference values were evaluated with the use of guidelines from clinical chemistry. Responses from the 29 participating echocardiographic laboratories were evaluated for their practice of quantitative echocardiographic interpretation. There is considerable heterogeneity in the echocardiographic reference values available in the literature. There is also a lack of agreement in the literature and among echocardiographers regarding the partitioning of reference values (by sex, ethnicity, or age), the anthropometric measure to be used for indexation, and the choice of cut-points for categorizing values within the abnormal range. Conclusions We advocate that echocardiographic reference limits be standardized and a consensus generated regarding the partitioning of reference limits and the indexation of echocardiographic measurements, Such measures can aid in quantitative echocardiographic interpretation and render

关键词：年龄因素体质化学临床/标准大陆人口群超声心动描记术/标准超声心动描记术/发展趋势人种群健康知识态度实践心脏病/超声检查实验室医院/标准马萨诸塞参考值性别因素青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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A pilot study to assess the safety of dobutamine stress echocardiography in the emergency department evaluation of cocaine-associated chest pain

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ANNALS OF EMERGENCY MEDICINE 2001年第1期38卷 42-48页

作者： Dribben, WH Kirk, MA Trippi, JA Cordell, WH Indiana Univ Dept Emergency Med Indianapolis IN 46204 USA Indiana Univ Sch Med Indianapolis IN USA Indiana Poison Ctr Indianapolis IN USA Methodist Hosp Dept Cardiol Indianapolis IN USA

Study objective: Chest pain in the setting of cocaine use poses a diagnostic dilemma. Dobutamine stress echocardiography (DSE) is a widely available and sensitive test for evaluating cardiac ischemia. Because of the theoretical concern regarding administration of dobutamine in the setting of cocaine use, we conducted a pilot study to assess the safety of DSE in emergency department patients with cocaine-associated chest pain. Methods: A prospective case series was conducted in the intensive diagnostic and treatment unit in the ED of an urban tertiary-care teaching hospital. Patients were eligible for DSE if they had used cocaine within 24 hours preceding the onset of chest pain and had a normal ECG and tropinin I level. Patients exhibiting signs of continuing cocaine toxicity were excluded from the study. Ail patients were admitted to: the hospital for serial testing after the DSE testing in the intensive diagnostic and treatment unit. Results: Twenty-four patients were enrolled. Two patients had inadequate resting images, one DSE was terminated because of inferior hypokinesis, another DSE was terminated because of a rate-related atrial conduction deficit, and 1 patient did not reach the target heart rate. Thus, 19 patients completed a DSE and reached their target heart rates. None of the patients experienced signs of exaggerated adrenergic response, which was defined as a systolic blood pressure of greater than 200 mm Mg or the occurrence of tachydysrhythmias (excluding sinus tachycardia). Further suggesting lack of exaggerated adrenergic response, 13 (65%) of 20 patients required supplemental atropine to reach their target heart rates. Conclusion: No exaggerated adrenergic response was detected when dobutamine was administered to patients with cocaine-related chest pain.

关键词：强心药/诊断应用胸痛/化学诱导胸痛/病理生理学胸痛/超声检查可卡因相关性障碍/并发症诊断鉴别多巴酚丁胺/诊断应用超声心动描记术/方法超声心动描记术/标准心电描记术急诊处理/方法急诊处理/标准运动试验/方法运动试验/标准心率/药物作用高血压/化学诱导心肌缺血/化学诱导心肌缺血/病理生理学心肌缺血/超声检查试点项目前瞻性研究安全拟交感神经药/诊断应用心动过速/化学诱导成年人人类中年人

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Accuracy of imaging technologies in the diagnosis of acute cardiac ischemia in the emergency department: A meta-analysis

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ANNALS OF EMERGENCY MEDICINE 2001年第5期37卷 471-477页

作者： Ioannidis, JPA Salem, D Chew, PW Lau, J New England Med Ctr Div Clin Care Res Evidence Based Practice Ctr Boston MA 02111 USA

Study objective: We sought to quantitatively evaluate the evidence on the diagnostic performance of imaging technologies (including rest and stress echocardiography and technetium-99m sestamibi scanning) far the diagnosis of acute cardiac ischemia and acute myocardial infarction in the emergency department. Methods: We conducted a systematic review and meta-analysis of the English-language literature published between 1966 and December 1998. Both prospective and retrospective studies qualified for the assessment of diagnostic performance. Diagnostic performance was assessed by means of random-effect estimates of test sensitivity, specificity, and the diagnostic odds ratio and was summarized by using summary receiver-operating characteristic curves. Results: Diagnostic accuracy was evaluated in 10 studies of rest echocardiography, 2 studies of dobutamine stress echocardiography, and 6 studies of technetium-99m sestamibi scanning, However, only 3 rest echocardiography and 5 technetium-99m sestamibi studies evaluated patients strictly in the ED setting. Patient populations were often highly selected to represent low- or moderate-risk groups. When limited to ED studies, rest echocardiography showed excellent sensitivity of 93% (95% CI, 81% to 97%) and goad specificity of 66% (95% CI, 43% to 83%). The results were similar when all studies were considered, including data from reports of admitted patients and patients sent to the cardiac care unit. There was insufficient literature on stress echocardiography in the ED to properly assess the technology. Technetium-99m sestamibi scanning also showed excellent sensitivity (range, 91.5% to 100%) and good specificity (range, 49.3% to 84.4%) for acute myocardial infarction;for acute cardiac ischemia, the random-effects pooled sensitivity was 89% (95% CI, 73% to 96%), and the pooled specificity was 77% (95% CI, 63% to 87%). Conclusion: For selected low- and moderate-risk patient groups, echocardiography and technetium-99m sestami

关键词：急性病偏倚(流行病学) 诊断显像/方法诊断显像/标准超声心动描记术/标准急诊处理/方法急诊处理/标准循证医学运动试验/标准心肌梗死/诊断心肌梗死/流行病学心肌缺血/诊断心肌缺血/流行病学比值比患病率前瞻性研究可重复性结果研究设计回顾性研究危险因素敏感性与特异性 99m锝甲氧基异丁基异腈/诊断应用技术评估生物医学人类

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American College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing - A report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第4期36卷 1441-1453页

作者： Rodgers, GP Ayanian, JZ Balady, G Beasley, JW Brown, KA Gervino, EV Paridon, S Quinones, M Schlant, RC Winters, WL Achord, JL Boone, AW Hirshfeld, JW Lorell, BH Rodgers, GP Tracy, CM Weitz, HH Amer Coll Cardiol Sci & Res Serv Bethesda MD 20814 USA Amer Heart Assoc Div Cardiovasc Sci Dallas TX 75231 USA

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Efficient utilization of echocardiography for the assessment of left ventricular systolic function

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AMERICAN HEART JOURNAL 2000年第3期139卷 394-398页

作者： Talreja, D Gruver, C Sklenar, J Dent, J Kaul, S Univ Virginia Med Ctr Div Cardiovasc Charlottesville VA 22908 USA

Background We hypothesized that patients could be selected for echocardiographic evaluation of left ventricular (IV) systolic function on the basis of historic, clinical, radiographic, and electrocardiographic criteria. Methods and Results We prospectively evaluated 300 consecutive inpatients referred for the echocardiographic assessment of LV function, of whom 124 (41%) had LV systolic dysfunction (LVSD) (IV ejection fraction <0.45). Among the historic variables, male sex was the only predictor of LVSD, whereas of the abnormal physical and radiographic findings, cardiomegaly on chest radiography was the only predictor. Among the electrocardiographic findings, the presence of left bundle branch block was positively correlated with the presence of LVSD, whereas a normal electrocardiogram was negatively correlated with this finding. Only 2 patients with LVSD had a normal electrocardiogram. The addition of significant predictors on physical examination and chest radiography doubled the predictive value of the historic variables for determining LVSD. The addition of electrocardiographic findings further doubled the predictive valve of the model. Almost 45% of the predictive power of the final multivariate model (chi-square of 48 of the total chi-square of 108) was based on the absence of normal electrocardiogram in patients with LVSD. When chest radiographic findings were excluded from the model, the overall predictive power of the model did not change, with the normal electrocardiogram gaining greater prominence: Full 56% of the predictive power of the model (chi-square of 60 of the total chi-square of 108) resided in the ability of a normal electrocardiogram to discriminate between patients with and those without LVSD. Conclusions Historic, chest radiographic, and electrocardiographic variables can be used to predict low likelihood of LVSD on echocardiography. In particular, when the electrocardiogram is normal, it is extremely unlikely to have LVSD. It can be argued

关键词：束支传导阻滞/诊断心脏扩大/流行病学心脏扩大/放射摄影术卡方分布决策支持技术超声心动描记术/经济学超声心动描记术/标准心电描记术发病率似然函数 Logistic模型多元分析病人遴选体格检查试验预期值前瞻性研究性别分布心缩期心室功能障碍左/诊断心室功能障碍左/流行病学心室功能左/生理学老年人女(雌)性人类男(雄)性中年人

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DIAGNOSTIC ACCURACY OF AN ULTRASONIC MULTIPLE TRANSDUCER CARDIAC IMAGING SYSTEM

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AMERICAN HEART JOURNAL 1975年第3期90卷 329-334页

作者： POPP, RL BROWN, OR HARRISON, DC STANFORD UNIV MED CTRSCH MEDCARDIOL DIVSTANFORDCA 94305

Eighty patients with various forms of heart disease were studied with the use of a newly developed ultrasonic system having 20 transducers arranged in a linear array. This system allows visualization of the heart in two dimensions in real time. All 15 patients with the mitral valve prolapse syndrome, 13 patients with mitral stenosis, five patients with pericardial effusion, four patients with atrial septal defect, and one patient with left ventricular dyssynergy were properly recognized with this system. One of five patients with hypertrophic myopathy and one of four patients with congestive myopathy were not recognized with this system. Criteria for the recognition of these conditions are presented as well as the probable cause for false-positive and false-negative diagnoses in this series. Since only qualitative criteria were used, it was not possible to differentiate patients with coronary artery disease or patients with left ventricular volume overload from patients without cardiac pathology. The accuracy of this new system was judged against the clinical examination, conventional echocardiography, cardiac catheterization, and left ventricular angiography. It is assumed that the criteria for diagnosis developed during this study will be supplemented and the equipment improved in the future; however, the ease of operation of this system and the relative accuracy of diagnosis at this stage of its development are extremely interesting. It presents an excellent opportunity to obtain additional information about the cardiac patient without using invasive procedures and without risk.

关键词：心脏扩大/诊断误诊超声心动描记术/仪器和设备超声心动描记术/方法超声心动描记术/标准评价研究心脏室壁瘤/诊断心脏病/诊断房间隔缺损/诊断二尖瓣闭锁不全/诊断二尖瓣狭窄/诊断示波测量法心包积液/诊断换能器录像磁带人类

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正常超声心动图几项指标测值与分析Ⅱ：50例正常人B型实时扇形扫描超声心动图心腔内的初步测值

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天津医科大学学报 1983年第2期 79-88页

作者：张承宗天津医学院第二附属医院

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正常人超声心动图几项指标的测值与分析Ⅰ、100例正常人M型超声心动图常用指标测值

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天津医科大学学报 1983年第2期 70-79页

作者：张承宗天津医学院第二附属医院

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PHOTOGRAPHIC TECHNIQUES FOR RETRIEVING ECHOCARDIOGRAPHIC IMAGES FROM SUB-STANDARD RECORDINGS

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JOURNAL OF CLINICAL ULTRASOUND 1978年第5期6卷 349-352页

作者： SILVERMAN, NH BUNKER, WE Cardiovascular Research Institute and the Department of Pediatrics University of California San Francisco California 94143

A technique is described for photographing damaged echocardiograms with a lithographic film. This is a high contrast film that reproduces either black or white, without intermediate gray tones, depending on exposure t... 详细信息

关键词：复制技术/方法超声心动描记术/标准摄影术/方法质量控制

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