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流行病学:据估计,美国CHF病人在200万以上。据Framingham研究证明,CHF的年发病率2‰。1970至82年间,出院诊断为CHF的人数由57万上升至155.7万,增加1倍。诊断:心脏扩大和心功能障碍并非就是显性CHF。据Harlan等分析,三分之二患者主诉呼吸困难,但对临床CHF的诊断特异性不足60%;端坐呼吸和阵发性夜间呼吸困难特异性高,但敏感性差(20～30%)。此外,上述症状无病因特异性,不能鉴别左室衰竭、肺心病与原发性肺病。CHF体征敏感性差,但却甚为特异。外周水肿、肺部罗音、第三心音或颈静脉怒张等,敏感性约10～30%,但特异性各为90%以上。作者发现,75%患者心胸比值>50%(胸部X线片),84%患者左室射血分数<45%(放射性核素血管造影法),85%患者左室舒张末期内径>54
Epidemiology: It is estimated that more than 2 million CHF patients in the United States. According to Framingham research, the annual incidence of CHF is 2 ‰. Between 1970 and 1982, the number of patients diagnosed with CHF rose from 570,000 to 1,557,000, doubling. Diagnosis: Cardiac enlargement and cardiac dysfunction are not dominant CHF. According to Harlan et al., Two thirds of patients complained of dyspnea but had less than 60% specificity for clinical diagnosis of CHF. CSP and paroxysmal nocturnal dyspnea were highly specific but poorly sensitive (20-30%). In addition, the above symptoms are etiologic and can not identify left ventricular failure, pulmonary heart disease and primary lung disease. CHF signs of poor sensitivity, but very specific. Peripheral edema, pulmonary rales, third heart sound or jugular vein engorgement, the sensitivity of about 10 to 30%, but the specificity of more than 90%. The authors found 75% of patients had a cardiothoracic ratio of> 50% (chest X-ray), 84% of patients had a left ventricular ejection fraction <45% (radionuclide angiography) and 85% of patients had a LV end-diastolic diameter> 54