Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California.
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California.
J Am Soc Echocardiogr. 2019 Mar;32(3):404-411. doi: 10.1016/j.echo.2018.10.007. Epub 2018 Dec 28.
Pediatric heart transplant patients (PedHtx) require frequent monitoring by echocardiography (echo); however, they often live far from hospitals with pediatric echo services, resulting in urgent/emergent transfers to specialized institutions. Our primary objective was to evaluate the feasibility of parental acquisition of echo images to assess left ventricular (LV) systolic function in PedHtx using a handheld echo device. Secondary objectives included retesting for skill maintenance and in patients with decreased LV systolic function.
During a routine clinic visit, parents received 1-hour training with a handheld echo device to acquire images in parasternal short-axis and apical views. Parents recorded images on their children at training completion and 24 hours later at home. An independent echocardiographer assessed clinic, training, and home echos for LV systolic function.
Fifteen PedHtx (mean age of 12.6 years of age; range, 4.1-16.7) were enrolled. All parents could acquire home images adequate for qualitative assessment of LV systolic function with no discrepancy compared with clinical echos. LV ejection fraction (LVEF) could be calculated (5/6 area-length method) in 86% of training and 43% of home echos with <10% difference in LVEF measurements between home and clinic echos. Five parents repeated home echos >12 months later. All home echos were adequate for qualitative assessment of LV systolic function (LVEF measurable in two). Additionally, five heart failure patients with decreased LV systolic function (mean age of 8.6 years; range 1.9-15.1) were enrolled. All home echos were adequate for qualitative assessment of LV systolic function (LVEF measurable in one).
Our results suggest that parental home echo acquisition using a handheld echo device is feasible and adequate for qualitative assessment of LV systolic function in PedHtx. However, quantitative assessment of LV systolic function, especially in patients with dysfunction, and retention of the skill set without additional training are suboptimal.
儿科心脏移植患者（PedHtx）需要通过超声心动图（echo）进行频繁监测；然而，他们通常居住在远离设有儿科 echo 服务的医院的地方，导致需要紧急/紧急转至专门的机构。我们的主要目标是评估父母使用手持式超声心动图设备获取超声心动图图像来评估 PedHtx 左心室（LV）收缩功能的可行性。次要目标包括在 LV 收缩功能降低的患者中进行技能保持和重新测试。
在常规诊所就诊期间，父母接受了 1 小时的手持式超声心动图设备培训，以获取胸骨旁短轴和心尖切面的图像。父母在培训完成和 24 小时后在家中为孩子记录图像。一位独立的超声心动图医师评估了诊所、培训和家庭超声心动图的 LV 收缩功能。
共纳入 15 名 PedHtx（平均年龄 12.6 岁；范围，4.1-16.7）。所有父母都可以在家中获取足以进行 LV 收缩功能定性评估的图像，与临床超声心动图无差异。可以计算左心室射血分数（LVEF）（5/6 面积长度法），在 86%的培训和 43%的家庭超声心动图中，家庭和诊所超声心动图之间的 LVEF 测量值差异<10%。5 位父母在 12 个月后重复家庭超声心动图检查。所有家庭超声心动图都足以进行 LV 收缩功能的定性评估（LVEF 可测量两次）。此外，还纳入了 5 名 LV 收缩功能降低的心力衰竭患者（平均年龄 8.6 岁；范围 1.9-15.1）。所有家庭超声心动图都足以进行 LV 收缩功能的定性评估（LVEF 可测量一次）。
我们的结果表明，使用手持式超声心动图设备进行父母家庭超声心动图采集是可行的，足以评估 PedHtx 的 LV 收缩功能。然而，LV 收缩功能的定量评估，尤其是在功能障碍患者中，以及在没有额外培训的情况下保持技能水平并不理想。
