The contribution given by pharmacodynamic tests in phonomechanocardiography to cardiovascular diagnosis was tested by means of an expert system, in order to make an objective evaluation. The expert system,designed in our laboratory for diagnosis in noninvasive cardiology, evaluated the clinical and noninvasive data of 283 patients affected by one or more cardiovascular diseases. The following patients’ data were considered; symptoms and signs, chest X-ray, electrocardiography, phonomechanocardiographic recording at rest and then with pharmacodynamic tests (methoxamine, isoproterenol/amyl nitrite). Without considering pharmacodynamic tests,the system was able to obtain at least 1 correct diagnosis in 217/283 cases (77%), while by adding dynamic phonomechanocardiography data the system performance significantly improved, with 243 correct diagnoses (85.9%;p < 0.0001). Without dynamic tests, the expert system could identify all the coexistent heart diseases present in 152 patients (53.7%). With dynamic tests, the number of patients correctly diagnosed increased significantly (180 cases,63.6%; p < 0.001). The present study thus confirms the usefulness of dynamic tests in noninvasive cardiovascular diagnosis. Furthermore a new and original function of an expert system is presented in that it may be used as a method to compare and judge diagnostic tests in a fair, possibly objective, way.

Keywords:
Computer-assisted diagnosis, Phonomechanocardiography, Microcomputer
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1990
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