Impact of experience on visual and Simpson's biplane echocardiographic assessment of left ventricular ejection fraction

IF 1.3 4区医学 Q4 PHYSIOLOGY Clinical Physiology and Functional Imaging Pub Date : 2024-12-02 DOI:10.1111/cpf.12918

S. Akil, J. Castaings, P. Thind, T. Åhlfeldt, M. Akhtar, A. T. Gonon, M. Quintana, K. Bouma

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Abstract

Background

In clinical routine, health care professionals with various levels of experience assess left ventricular ejection fraction (LVEF) by echocardiography. The aim was to investigate to what extent visual and Simpson's biplane assessment of LVEF, using two-dimensional (2D) transthoracic echocardiography (TTE), is affected by the evaluator's experience.

Methods

Ultrasound images of 140 patients were assessed, visually and with Simpson's biplane method, by six evaluators divided into three groups based on echocardiographic experience level (beginner, intermediate and expert). The evaluators were blinded to each other's LVEF assessments. Bland-Altman analyses (bias±SD) were performed to assess agreement. P-values < 0.05 with the performed paired t-test were considered statistically significant.

Results

Level of agreement in LVEF was good between evaluators within the expert group: visual = LVEF_{expert 1} vs LVEF_{expert 2}: −0.4 ± 6.4 (p = 0.46); Simpson's biplane = LVEF_{expert 1} vs LVEF_{expert 2}: 0.96 ± 7.0 (p = 0.11), somewhat lower within the intermediate group: visual = LVEF_{intermediate 1} vs LVEF_{intermediate 2}: −1.2 ± 4.4 (p = 0.004); Simpson's biplane = LVEF_{intermediate 1} vs LVEF _{intermediate 2}: −3.3 ± 5.0 (p < 0.001) and lowest for beginners: visual = LVEF_{beginner 1} vs LVEF_{beginner 2}: 2.3 ± 9.8 (p = 0.007), Simpson's biplane = LVEF_{beginner 1} vs LVEF beginner 2: −1.8 ± 8.7 (p = 0.02). The agreement between LVEF_expert and LVEFs by the two other groups was: visual = LVEF_expert vs LVEF_beginner: 1.5 ± 6.0 (p = 0.005); LVEF_intermediate: −3.0 ± 4.4 (p < 0.001) and Simpson's biplane = LVEF_expert vs LVEF_beginner: 3.2 ± 6.3 (p < 0.001); LVEF_intermediate: −2.2 ± 4.7 (p < 0.001).

Conclusions

The evaluator's level of experience affects visual and Simpson's biplane assessment of LVEF by 2D-TTE, with highest variability being among beginners. Furthermore, a second opinion is recommended when assessing reduced LVEF even for evaluators with intermediate and expert experience.

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经验对视觉和辛普森双翼超声心动图评估左心室射血分数的影响。

背景：在临床常规中，不同经验水平的医护人员通过超声心动图评估左室射血分数（LVEF）。目的是研究使用二维（2D）经胸超声心动图（TTE）对LVEF的视觉和辛普森双翼评估在多大程度上受到评估者经验的影响。方法：对140例患者的超声图像进行评估，采用辛普森双翼法，由6名评估者根据超声心动图经验水平分为3组（初级、中级和专家级）。评估者对彼此的LVEF评估是不知情的。采用Bland-Altman分析（偏倚±标准差）评估一致性。p值结果：专家组内评估者对LVEF的一致程度良好：视觉= LVEFexpert 1 vs LVEFexpert 2: -0.4±6.4 (p = 0.46)；辛普森氏双翼= LVEFexpert 1 vs LVEFexpert 2: 0.96±7.0 (p = 0.11)，中间组略低：目视= LVEFintermediate 1 vs LVEFintermediate 2: -1.2±4.4 (p = 0.004)；Simpson’s双翼= LVEF中级1 vs LVEF中级2:-3.3±5.0 (p = 0.007), Simpson’s双翼= LVEF初级1 vs LVEF初级2:-1.8±8.7 （p = 0.02）。LVEFexpert与其他两组LVEFs的一致性为：visual = LVEFexpert vs lvefbeginners: 1.5±6.0 (p = 0.005)；结论：评估者的经验水平影响2D-TTE对LVEF的视觉和Simpson双翼评估，在初学者中差异最大。此外，在评估降低的LVEF时，即使对于具有中级和专家经验的评估人员，也建议采用第二种意见。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Physiology and Functional Imaging 医学-生理学

CiteScore

3.40

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Clinical Physiology and Functional Imaging publishes reports on clinical and experimental research pertinent to human physiology in health and disease. The scope of the Journal is very broad, covering all aspects of the regulatory system in the cardiovascular, renal and pulmonary systems with special emphasis on methodological aspects. The focus for the journal is, however, work that has potential clinical relevance. The Journal also features review articles on recent front-line research within these fields of interest. Covered by the major abstracting services including Current Contents and Science Citation Index, Clinical Physiology and Functional Imaging plays an important role in providing effective and productive communication among clinical physiologists world-wide.