Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.
Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
Heart Lung Circ. 2020 May;29(5):703-709. doi: 10.1016/j.hlc.2019.04.008. Epub 2019 Apr 26.
Three-dimensional echocardiography (3D-Echo) performed by novice health care staff to measure left ventricular ejection fraction (LVEF) could allow cost-effective screening and monitoring for left ventricular systolic dysfunction (LVSD) prior to the development of heart failure. The aim of this study was to determine feasibility and accuracy of cardiac nurses (after completing focussed training) independently acquiring 3D-Echo images, and measuring LVEF using semi-automated software when compared to an echosonographer.
One echosonographer and three cardiac nurses acquired 3D-Echo images on 73 patients (62 ± 16 years, 62% male) with good image quality, and subsequently measured LVEF using a semi-automated algorithm.
Overall feasibility was 89% with the three nurses successfully acquiring 3D-Echo images suitable for LVEF assessment in 65 of the 73 patients. High accuracy (r = 0.82; p < 0.0001) with minimal bias (+0.1, -10.6 to +10.8 limits of agreement; p = 0.91) was observed comparing the nurses to the echosonographer for measuring LVEF. Individual nurses demonstrated high feasibility (86%-92%), accuracy (r = 0.83-0.87; all p < 0.0001) and intra-observer reproducibility (r = 0.96-0.97; all p < 0.0001), with good inter-observer consistency in accuracy compared to the echosonographer (one-way analysis of variance p = 0.559).
We have demonstrated that, following a focussed training protocol, it was feasible for cardiac nurses to acquire 3D-Echo images of sufficient image quality to allow measurement of LVEF using a semi-automated algorithm, with comparable accuracy and intra-observer variability to an expert echosonographer. This could potentially allow the broader application of echocardiography to screen for LVSD in high-risk cohorts.
新手医护人员进行三维超声心动图（3D-Echo）测量左心室射血分数（LVEF），可以在心力衰竭发生前，进行经济有效的左心室收缩功能障碍（LVSD）筛查和监测。本研究旨在确定经过集中培训的心脏护士独立采集 3D-Echo 图像并使用半自动软件测量 LVEF 的可行性和准确性，并与超声心动图专家进行比较。
一名超声心动图专家和三名心脏护士对 73 名患者（62±16 岁，62%为男性）进行了 3D-Echo 图像采集，图像质量良好，随后使用半自动算法测量 LVEF。
三名护士中有两名成功采集了 73 名患者中 65 名患者的适合 LVEF 评估的 3D-Echo 图像，总体可行性为 89%。两名护士测量 LVEF 的结果与超声心动图专家高度一致（r=0.82；p<0.0001），几乎没有偏差（+0.1，-10.6 至+10.8 的一致性界限；p=0.91）。个别护士的可行性（86%-92%）、准确性（r=0.83-0.87；均 p<0.0001）和观察者内可重复性（r=0.96-0.97；均 p<0.0001）都很高，与超声心动图专家相比，观察者间的准确性一致性也很好（单向方差分析 p=0.559）。
我们证明，在经过集中培训后，心脏护士可以采集到足够质量的 3D-Echo 图像，以便使用半自动算法测量 LVEF，其准确性和观察者内变异性与超声心动图专家相当。这可能使超声心动图更广泛地应用于高危人群的 LVSD 筛查。
