Shmueli Hezzy, Burstein Yuval, Sagy Iftach, Perry Zvi H, Ilia Ruben, Henkin Yaakov, Shafat Tali, Liel-Cohen Noah, Kobal Sergio L
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Echocardiography. 2013 Jul;30(6):621-6. doi: 10.1111/echo.12122. Epub 2013 Jan 24.
Rheumatic heart disease (RHD) is common and remains a major cause of morbidity, particularly in developing countries. Its diagnosis relies on expertise-dependent echocardiographic studies. We evaluated the accuracy of briefly trained examiners in identifying RHD utilizing a hand-carried cardiac ultrasound (HCU) device.
Three medical students received 8 hours of training in cardiac ultrasound, focused on assessment of rheumatic valve injury and its complications, using a prototype of HCU device, OptiGo. The students, blinded to the patients' medical condition, performed an auscultation-based physical examination and a focused HCU study on volunteers and patients with known RHD. A standard echocardiography study was used to validate the results.
Each student performed a physical examination followed by an HCU study on 45 subjects (mean age 57 ± 14 years, 52% men), 14 of whom (31%) had rheumatic mitral valve injury. The students' averaged sensitivity for diagnosing RHD by HCU examination was 81%, while specificity was 95%. The interrater agreement (kappa) of the 3 students' HCU study and the standard echocardiography examination were between 0.55 and 0.88 (P < 0.01), and among the students themselves between 0.57 and 0.74 (P < 0.01), as students 1 and 2 had better results than student 3. Auscultation-based physical examination rendered low sensitivity (16%) for diagnosing rheumatic valve complications, namely mitral regurgitation and stenosis; however, it improved by 26% when students based their diagnosis on an HCU study.
The ability to detect rheumatic valve injury using a portable ultrasound device by operators who only received brief echocardiographic training is remarkably high. However, the diagnosis of RHD complications is only modest. This result highlights the utility of portable cardiac ultrasound devices operated by basically trained personnel as a valuable diagnostic tool for RHD.
风湿性心脏病（RHD）很常见，仍然是发病的主要原因，尤其是在发展中国家。其诊断依赖于依赖专业知识的超声心动图检查。我们评估了使用手持式心脏超声（HCU）设备的经过短期培训的检查人员识别RHD的准确性。
三名医学生接受了8小时的心脏超声培训，重点是使用HCU设备原型OptiGo评估风湿性瓣膜损伤及其并发症。这些学生对患者的病情不知情，对志愿者和已知患有RHD的患者进行了基于听诊的体格检查和重点HCU研究。使用标准超声心动图研究来验证结果。
每名学生对45名受试者（平均年龄57±14岁，52%为男性）进行了体格检查，随后进行了HCU研究，其中14名（31%）患有风湿性二尖瓣损伤。学生通过HCU检查诊断RHD的平均敏感性为81%，特异性为95%。三名学生的HCU研究与标准超声心动图检查之间的组间一致性（kappa）在0.55至0.88之间（P<0.01），学生之间的一致性在0.57至0.74之间（P<0.01），因为学生1和学生2的结果优于学生3。基于听诊的体格检查对诊断风湿性瓣膜并发症（即二尖瓣反流和狭窄）的敏感性较低；然而，当学生基于HCU研究进行诊断时，敏感性提高了~26%。
仅接受过短期超声心动图培训的操作人员使用便携式超声设备检测风湿性瓣膜损伤的能力非常高。然而，对RHD并发症的诊断仅为中等水平。这一结果凸显了由基本培训人员操作的便携式心脏超声设备作为RHD有价值诊断工具的实用性。
