title: The clinical utility of echocardiography as a cardiological diagnostic tool in poor resource settings.
abstract: BACKGROUND
  There has been a decline in the auscultatory and other clinical skills of physicians especially in developed countries. The advent of echocardiography has revolutionized the diagnosis of cardiovascular diseases and made up for the decline in clinical skills.
  
  
  OBJECTIVE
  To assess the sensitivity and specificity of auscultatory and clinical skills in the diagnosis of cardiovascular diseases using echocardiography as the gold standard.
  
  
  METHODS
  All the adult echocardiographic studies (321) performed over a 1-year period were collated for analysis. The clinical indications of the studies were compared with the final diagnoses by echocardiography. The sensitivity and specificity of the clinical diagnosis of hypertensive heart disease (HHD), rheumatic heart disease (RHD), and the cardiomyopathies were determined.
  
  
  RESULTS
  Of the 244 (76.0%) clinically diagnosed as HHD, 188 (58.6%) were confirmed by echocardiography. For RHD 9 (2.8%) were diagnosed clinically while on echocardiography, 13 (4.1%) were diagnosed. All the 31 (9.7%) cases of dilated cardiomyopathy were confirmed on echocardiography. No case of ischemic heart disease was confirmed. Seventy-one (22.0%) had normal studies. The sensitivity of clinical diagnosis for RHD was low (41.7%) while for HHD and dilated cardiomyopathy, sensitivity was high, 95.7% and 75.0%, respectively. Specificity was high for all three cardiovascular diseases analyzed.
  
  
  CONCLUSIONS
  Auscultatory and clinical skills are still sensitive and specific tools in the diagnosis of cardiovascular diseases in developing countries and should be sustained. However, echocardiography is indispensable in the diagnosis of cases with subtle clinical signs and should be made more available and affordable.
authors: Department of Medicine, Cardiology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria. vic_ansa@yahoo.com
authors: V O
authors: VO
authors: Ansa
authors: C O
authors: CO
authors: Odigwe
authors: R O
authors: RO
authors: Agbulu
authors: I
authors: I
authors: Odudu-Umoh
authors: V
authors: V
authors: Uhegbu
authors: U
authors: U
authors: Ekripko
mesh_terms: D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D003906:Developing Countries; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D015203:Reproducibility of Results; D012189:Retrospective Studies