Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Uganda Heart Institute, Kampala, Uganda.
Glob Heart. 2018 Jun;13(2):105-111. doi: 10.1016/j.gheart.2017.05.004. Epub 2017 Sep 1.
The Wilkins score and commissural calcification scores predict outcomes after percutaneous balloon mitral valvuloplasty. However, many cardiologists are inadequately trained in their application-both in the United States where the incidence of rheumatic heart disease has fallen and in rheumatic heart disease endemic countries where training infrastructure is weak.
This study sought to develop a computer-based educational module teaching 2 scoring systems for rheumatic mitral stenosis and to validate the module among cardiology fellows in the United States and Uganda.
We developed a module organized into 3 sets of 10 echocardiograms each. The module was completed by 13 cardiology fellows from 2 academic centers in the United States and 1 in Uganda. Subject answers were compared with a score assigned by 2 experts in echocardiography. The primary outcome was change in subjects' accuracy from set 1 to set 3, measured by mean absolute deviation from expert scores. Secondary outcomes included change in interoperator variability and individual subject bias from set 1 to set 3.
The mean absolute deviations from expert scores in sets 1 and 3 were 2.09 and 1.82 for the Wilkins score (possible score range 0 to 16) and 1.13 and 0.94 for the commissural calcification score (possible score range 0 to 4). The change from set 1 to set 3 was statistically significant only for 1 of the Wilkins component scores (leaflet calcification, p < 0.001.) No change was seen in the interoperator variability. Individual subject bias in assigning the total Wilkins score was reduced from set 1 to set 3.
Use of this module has the potential to enhance the training of cardiologists in the echocardiographic assessment of mitral stenosis. Modified versions of this module or similar ones should be tested in targeted populations of cardiology trainees with the most exposure to mitral stenosis interventions.
Wilkins 评分和瓣环钙化评分可预测经皮球囊二尖瓣成形术后的结果。然而，许多心脏病专家在这两个评分的应用方面都没有得到充分的培训，这种情况在美国（风湿性心脏病的发病率已经下降）和风湿性心脏病流行的国家（培训基础设施薄弱）都存在。
本研究旨在开发一个基于计算机的教育模块，教授两种用于风湿性二尖瓣狭窄的评分系统，并在美国和乌干达的心脏病专家中验证该模块。
我们开发了一个模块，分为 3 组，每组 10 个超声心动图。该模块由来自美国 2 个学术中心和乌干达的 13 名心脏病专家完成。根据 2 名超声心动图专家的评分，对受试者的答案进行比较。主要结果是通过与专家评分的平均绝对偏差来衡量受试者从第 1 组到第 3 组的准确性变化。次要结果包括从第 1 组到第 3 组的操作者间变异性和个体受试者偏差的变化。
Wilkins 评分（可能的评分范围为 0 到 16）在第 1 组和第 3 组的平均绝对偏差分别为 2.09 和 1.82，在第 1 组和第 3 组的平均绝对偏差分别为 1.13 和 0.94。只有 Wilkins 评分的一个分量（瓣叶钙化）从第 1 组到第 3 组的变化具有统计学意义（p<0.001）。操作者间的变异性没有变化。在分配总 Wilkins 评分时，个体受试者的偏差从第 1 组到第 3 组有所降低。
使用该模块有可能增强心脏病专家在超声心动图评估二尖瓣狭窄方面的培训。应该在接受二尖瓣狭窄介入治疗最多的心脏病学受训者的目标人群中测试这个模块的修改版本或类似的版本。
