School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Department of Cardiology, Prince Charles Hospital, Brisbane, Australia.
School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Department of Cardiology, Fujita-Health University, Nagoya, Japan.
J Am Soc Echocardiogr. 2017 Nov;30(11):1081-1090. doi: 10.1016/j.echo.2017.06.010. Epub 2017 Aug 7.
The application of left ventricular (LV) global strain by speckle-tracking is becoming more widespread, with the potential for incorporation into routine clinical echocardiography in selected patients. There are no guidelines or recommendations for the training requirements to achieve competency. The aim of this study was to determine the learning curve for global strain analysis and determine the number of studies that are required for independent reporting.
Three groups of novice observers (cardiology fellows, cardiac sonographers, medical students) received the same standardized training module prior to undertaking retrospective global strain analysis on 100 patients over a period of 3 months. To assess the effect of learning, quartiles of 25 patients were read successively by each blinded observer, and the results were compared to expert for correlation.
Global longitudinal strain (GLS) had uniform learning curves and was the easiest to learn, requiring a minimum of 50 patients to achieve expert competency (intraclass correlation coefficient > 0.9) in all three groups over a period of 3 months. Prior background knowledge in echocardiography is an influential factor affecting the learning for interobserver reproducibility and time efficiency. Short-axis strain analysis using global circumferential stain and global radial strain did not yield a comprehensive learning curve, and expert level was not achieved by the end of the study.
There is a significant learning curve associated with LV strain analysis. We recommend a minimum of 50 studies for training to achieve competency in GLS analysis.
斑点追踪技术的左心室（LV）整体应变的应用越来越广泛，有可能在某些患者中纳入常规临床超声心动图。目前还没有关于实现能力所需的培训要求的指南或建议。本研究旨在确定整体应变分析的学习曲线，并确定独立报告所需的研究数量。
三组新手观察者（心脏病学研究员、心脏超声医师、医学生）在进行为期 3 个月的 100 例患者回顾性整体应变分析之前，接受了相同的标准化培训模块。为了评估学习效果，每个盲法观察者依次阅读了 25 例患者的四分之一，然后将结果与专家的结果进行相关性比较。
整体纵向应变（GLS）具有统一的学习曲线，最容易学习，所有三组在 3 个月的时间内，需要至少 50 例患者才能达到专家水平（组内相关系数>0.9）。超声心动图背景知识是影响观察者间可重复性和时间效率学习的一个因素。使用整体圆周应变和整体径向应变的短轴应变分析没有产生全面的学习曲线，到研究结束时也没有达到专家水平。
LV 应变分析存在显著的学习曲线。我们建议至少进行 50 项研究以达到 GLS 分析的能力。
