Can severe aortic stenosis be identified by emergency physicians when interpreting a simplified two-view echocardiogram obtained by trained echocardiographers?

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Critical Ultrasound Journal Pub Date : 2015-04-18 eCollection Date: 2015-01-01 DOI:10.1186/s13089-015-0022-8
Hasan Alzahrani, Michael Y Woo, Chris Johnson, Paul Pageau, Scott Millington, Venkatesh Thiruganasambandamoorthy
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引用次数: 7

Abstract

Background: Aortic stenosis (AS) is a common valve problem that causes significant morbidity and mortality. The goal of this study was to determine whether an emergency physician (EP) could determine severe AS by reviewing only two B-mode echocardiographic views (parasternal long axis (PSLA) and parasternal short axis (PSSA)) obtained by trained echocardiographers.

Methods: A convenience sample of 60 patients with no AS, mild/moderate AS or severe AS was selected for health record and echocardiogram review. The echocardiograms were performed in an accredited echocardiography laboratory. An EP blinded to the cardiologist's final report reviewed the PSLA and PSSA views after the cases were randomly sorted. Severe AS was defined as no cusp movement seen by the EP reviewers. A second EP independently reviewed 25% of randomly selected patients for inter-rater reliability. Collected data included patient demographics, EP interpretation and details of each echo view (quality, the number of cusps visualized, presence of calcification) and compared to final cardiology reports. Analyses included descriptive statistics, test characteristics for severe AS and kappa for agreement.

Results: The mean age was 75.3 years (range 18 to 90) with 36.7% females. The cardiologist's diagnosis was as follows: 38.3% severe AS, 28.3% mild/moderate AS and 33.3% no AS. The PSSA view was poorer in quality compared with the PSLA (33.3% vs. 13.3%, p = 0.02), but the PSSA view was better than PSLA to visualize all three cusps (83.3% vs. 0%, p = 0.001). There was no difference in the presence of calcification between the mild/moderate and severe AS groups (94.1% vs. 100.0%, p = 0.46). The sensitivity and specificity for EP diagnosis of severe AS was 75.0% (95% CI 56.7% to 85.4%) and 92.5% (83.3% to 97.7%). The kappa for severe AS was 0.69 (0.41 to 0.85), and there was no significant difference between observers in the quality of the view, presence of aortic calcification and the number of cusps visible.

Conclusions: PSLA and PSSA views obtained by trained echocardiographers can be interpreted by an EP with appropriate training to identify severe AS with good specificity. Further larger prospective studies are required before widespread use by EPs.

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急诊医生在解释训练有素的超声心动图师获得的简化双视图超声心动图时,是否可以识别严重的主动脉狭窄?
背景:主动脉瓣狭窄(Aortic stenosis, AS)是一种常见的瓣膜疾病,发病率和死亡率都很高。本研究的目的是确定急诊医师(EP)是否可以通过仅查看由训练有素的超声心动图医师获得的两个b型超声心动图(胸骨旁长轴(PSLA)和胸骨旁短轴(PSSA))来判断严重AS。方法:选取60例无AS、轻/中度AS和重度AS患者进行健康记录和超声心动图检查。超声心动图在认可的超声心动图实验室进行。在随机分类病例后,EP对心脏病专家的最终报告不知情,回顾了PSLA和PSSA视图。重度AS被定义为EP审查员没有看到尖头运动。第二个EP独立评估了随机选择的25%的患者的评分间可靠性。收集的数据包括患者人口统计学、EP解释和每个回声视图的细节(质量、可见尖峰的数量、钙化的存在),并与最终的心脏病学报告进行比较。分析包括描述性统计、严重AS的测试特征和一致性的kappa。结果:平均年龄75.3岁(18 ~ 90岁),女性占36.7%。心脏病专家的诊断如下:38.3%为重度as, 28.3%为轻/中度as, 33.3%为非as。与PSLA相比,PSSA视图的质量较差(33.3%对13.3%,p = 0.02),但PSSA视图比PSLA更好地显示所有三个尖点(83.3%对0%,p = 0.001)。在轻度/中度和重度AS组之间,钙化的存在没有差异(94.1%对100.0%,p = 0.46)。EP诊断严重AS的敏感性和特异性分别为75.0% (95% CI 56.7% ~ 85.4%)和92.5%(83.3% ~ 97.7%)。重度AS的kappa为0.69(0.41 ~ 0.85),观察者在观察质量、主动脉钙化的存在和可见尖点的数量上没有显著差异。结论:经过训练的超声心动图师获得的PSLA和PSSA图像可以由经过适当训练的EP解释,以良好的特异性识别严重AS。在EPs广泛应用之前,需要进行更大规模的前瞻性研究。
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来源期刊
Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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