The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure
The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure
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DOI：
10.1161/circulationaha.111.019216
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发表时间：
2011-12-20
期刊：
影响因子：
37.8
通讯作者：
Hoes, Arno W.
中科院分区：
文献类型：
--
作者：
Kelder, Johannes C.;Cramer, Maarten J.;Hoes, Arno W.
背景-非急性心力衰竭的早期诊断至关重要，因为及时启动循证治疗可以防止或减缓进一步的进展。在初级保健中诊断新发心力衰竭具有挑战性。方法和结果--这是一项具有外部验证的横断面诊断准确性研究。连续721名怀疑新发心力衰竭的患者在专门配备的心力衰竭门诊接受了标准化诊断检查，包括胸部X光、肺活量测定、心电图、N末端B型利钠肽原(NT-ProBNP)测定和超声心动图。心力衰竭的存在是由一个结果小组使用初始临床数据和6个月的随访数据确定的，与生物标记物数据无关。在721例患者中，207例(28.7%)有心力衰竭。来自病史的3项(年龄、冠状动脉疾病和环状利尿剂的使用)加上来自体检的6项(脉搏频率和规律性、心尖搏动移位、罗音、心脏杂音和颈静脉压升高)的组合显示出独立的诊断价值(c-统计学0.83)。NT-proBNP是最强大的辅助诊断试验，使c统计量增加到0.86，净重新分类改善69%(P
Background-Early diagnosis of nonacute heart failure is crucial because prompt initiation of evidence-based treatment can prevent or slow down further progression. To diagnose new-onset heart failure in primary care is challenging.Methods and Results-This is a cross-sectional diagnostic accuracy study with external validation. Seven hundred twenty-one consecutive patients suspected of new-onset heart failure underwent standardized diagnostic work-up including chest x-ray, spirometry, ECG, N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement, and echocardiography in specially equipped outpatient diagnostic heart failure clinics. The presence of heart failure was determined by an outcome panel using the initial clinical data and 6-month follow-up data, blinded to biomarker data. Of the 721 patients, 207 (28.7%) had heart failure. The combination of 3 items from history (age, coronary artery disease, and loop diuretic use) plus 6 from physical examination (pulse rate and regularity, displaced apex beat, rales, heart murmur, and increased jugular vein pressure) showed independent diagnostic value (c-statistic 0.83). NT-proBNP was the most powerful supplementary diagnostic test, increasing the c-statistic to 0.86 and resulting in net reclassification improvement of 69% (P