在先天性长QT综合征的诊断错误
Nathaniel W Taggart1, Carla M Haglund, David J Tester
1Department of Pediatrics/Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Circulation
|May 16, 2007
概括
许多被诊断患有长QT综合征 (LQTS) 的患者被过度诊断. 一家子专业诊所发现,只有27%的人有确定的LQTS,这突显了这种心脏通道病的诊断挑战.
科学领域:
- 心脏病学 心脏病学
- 遗传学 是一个遗传学.
- 临床诊断 临床诊断 临床诊断
背景情况:
- 长QT综合征 (LQTS) 是一种危及生命的心脏通道病变.
- LQTS可能被误诊为心,昏迷或.
- 提高意识可能会导致LQTS的过度诊断.
研究的目的:
- 评估LQTS分专科诊所和初始转诊诊断之间的诊断协议.
- 确定可疑LQTS病例中诊断差异的因素.
主要方法:
- 对176名患者的回顾性审查,这些患者被推用于LQTS评估.
- 首次转诊诊断与专家再评估诊断的比较.
- 将患者分类为确定的LQTS (D-LQTS),可能的LQTS (P-LQTS) 或没有LQTS (没有LQTS).
主要成果:
- 只有27%的患者患有D-LQTS; 41%的患者被诊断为没有LQTS.
- 基因测试在78%的D-LQTS和34%的P-LQTS中产生了积极的结果.
- 纠正的QT间隔 (QTc) 的错误计算和症状的误解是误诊的关键因素.
结论:
- 对LQTS的诊断一致性很低,只有不到三分之一的患者同意最初的诊断.
- 经过专家评估,很大一部分 (41%) 的转诊患者没有LQTS.
- 诊断错误源于QTc过高估计,边界QTc值和症状误解.
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