The diagnostic accuracy of combined clinical and noninvasive cardiac evaluation: comparison with findings at cardiac catheterization.

The accuracy of combined clinical and noninvasive cardiac diagnostic evaluation was prospectively examined in 108 consecutive patients referred to the heart station for echocardiographic examination prior to cardiac catheterization. History, physical examination, scalar electrocardiology, chest roentgenography, phonocardiography and pulse recording, and M-mode echocardiography were employed by the heart station cardiologist, who assigned one or more diagnoses to each patient. In addition, one of three management strategies was proposed for each patient: 1) surgery without cardiac catheterization; 2) medical therapy without cardiac catheterization; or 3) cardiac catheterization for clarification of the diagnosis. The results of the combined clinical and noninvasive evaluation were independently reviewed for each patient and compared with the diagnosis determined by cardiac catheterization, results of cardiac surgery, and total hospital course. Diagnostic predictions employing combined clinical and noninvasive cardiac evaluation were completely correct in 86% of patients, and management strategy was correct in 97% of individuals. In approximately one-half of all patients full cardiac catheterization or coronary arteriography was recommended. All management strategy errors and two-thirds of diagnostic errors occurred in patients with mitral regurgitation, aortic regurgitation, or coronary artery disease. Combined clinical and noninvasive evaluation results in accurate diagnostic information adequate for the formulation of appropriate management strategies in the majority of patients, but many individuals with cardiac disease still require invasive evaluation for complete diagnosis.