在因心律失常的右心室心肌病症而转诊的患者的诊断陷
James R Sampognaro1, Sean P Gaine1, Apurva Sharma1
1Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Heart rhythm
|September 1, 2023
概括
错误诊断出心律失常的右心室心肌病变 (ARVC) 是很常见的,影响到一半的转诊患者. 心脏MRI的误解是一个关键因素,导致不必要的植入式心脏转换器-除器 (ICD) 程序.
科学领域:
- 心脏病学 心脏病学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 由于非特异性症状和不确定的遗传检测,诊断心律失常性右室心肌病变 (ARVC) 是复杂的.
- 尽管修订了标准,ARVC的错误诊断仍然是一个临床挑战.
研究的目的:
- 确定ARVC转诊但最终被排除的患者的临床特征和诊断混因素.
- 了解疑似ARVC病例误诊背后的原因.
主要方法:
- 2011年1月至2019年9月期间对726名疑似或确诊的ARVC患者的分析.
- 对已确认ARVC患者和已排除ARVC患者的临床数据和诊断结果的回顾性审查.
主要成果:
- 在50.3%的转诊患者中 (n=365) 排除了ARVC.
- 常见的症状包括心,心室节律失常和胸痛.
- 心脏磁共振成像 (CMR) 的误解,特别是右心室异常和脂肪沉积,是主要的诊断错误.
- 不适当的植入式心脏转换器-除器 (ICD) 植入或建议发生在14.5%的误诊患者中.
结论:
- 对ARVC的错误怀疑或误诊很普遍,导致不适当的ICD干预.
- 心脏MRI误解是ARVC误诊的一个重要因素.
- 对于疑似ARVC转诊的患者来说,重新评估至关重要,以防止不必要的程序.
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