Szymański Piotr, Lipczyńska Magdalena, Klisiewicz Anna, Kraszewski Krzysztof, Konka Marek, Tyczyński Paweł, Hoffman Piotr
Pracownia Echokardiografii Kliniki Wad Wrodzonych Serca, Instytutu Kardiologii w Warszawie.
Przegl Lek. 2004;61(6):572-5.
Recent technological advances enabled miniaturization of echocardiographic machines and construction of portable "ultrasound stethoscopes", which enable rapid two-dimensional and color-Doppler imaging and supplement clinical examination of the heart. We present the results of systematic assessment of these devices in comparison with standard echocardiographic machines.
We prospectively examined with both ultrasound stethoscopes and standard echocardiographic machines 60 patients referred to our laboratory for routine echocardiographic examination. Image quality (score: 1 to 4; best to worst), accuracy in qualitative evaluation of valvular regurgitation and left ventricular function (ejection fraction) were directly compared. Color Doppler assessment of valvular regurgitation was graded on a standard four point scale. A two or more point difference was considered major. Ejection fraction was estimated (the ultrasound stethoscope is not equipped with appropriate software).
Image quality was significantly worse in the case of ultrasound stethoscope (2.6 vs 2.1; p<0.0001). Major differences in the assessment of regurgitant jets were present in 3 cases (5%) (1 mitral and 2 tricuspid). The degree of agreement was good in the case of mitral and pulmonary regurgitation (kappa=0.61 and 0.74 respectively), very good in the case of aortic regurgitation (kappa=0.80) and moderate in the case of tricuspid regurgitation (kappa=0.48). The differences in the assessment of aortic and mitral regurgitant jets correlated with the image quality (p<0.05). A Bland-Altman graph comparing the results of ejection fraction assessment revealed good agreement between methods.
Results of the systematic evaluation of the use of ultrasound stethoscopes in the rapid evaluation of left ventricular systolic function and valvular regurgitation. Although image quality achieved with the hand-held stethoscope was worse, nevertheless it was adequate for the purpose of performing rapid limited assessment of cardiac and valvular function.
最近的技术进步使得超声心动图机器得以小型化，并制造出了便携式“超声听诊器”，这些设备能够进行快速二维和彩色多普勒成像，辅助心脏的临床检查。我们展示了与标准超声心动图机器相比，对这些设备进行系统评估的结果。
我们前瞻性地使用超声听诊器和标准超声心动图机器对60名转诊至我们实验室进行常规超声心动图检查的患者进行了检查。直接比较了图像质量（评分：1至4；从最佳到最差）、瓣膜反流定性评估的准确性以及左心室功能（射血分数）。瓣膜反流的彩色多普勒评估按照标准四点量表进行分级。两点或更多点的差异被视为显著差异。射血分数通过估算得出（超声听诊器未配备合适的软件）。
超声听诊器的图像质量明显较差（2.6对2.1；p<0.0001）。3例（5%）（1例二尖瓣和2例三尖瓣）在反流束评估中存在显著差异。二尖瓣和肺动脉反流的一致性程度良好（kappa分别为0.61和0.74），主动脉反流的一致性程度非常好（kappa = 0.80），三尖瓣反流的一致性程度中等（kappa = 0.48）。主动脉和二尖瓣反流束评估的差异与图像质量相关（p<0.05）。比较射血分数评估结果的布兰德 - 奥特曼图显示两种方法之间一致性良好。
对超声听诊器在快速评估左心室收缩功能和瓣膜反流方面的系统评估结果。尽管手持式听诊器获得的图像质量较差，但对于快速进行有限的心脏和瓣膜功能评估而言仍然足够。
