Hjorth-Hansen Anna Katarina, Andersen Garrett Newton, Graven Torbjørn, Gundersen Guri Holmen, Kleinau Jens Olaf, Mjølstad Ole Christian, Skjetne Kyrre, Stølen Stian, Torp Hans, Dalen Håvard
Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
J Ultrasound Med. 2020 Dec;39(12):2313-2323. doi: 10.1002/jum.15341. Epub 2020 May 21.
To study the feasibility and accuracy of focused echocardiography by nurses supported by near-real-time interpretation via telemedicine by an experienced cardiologist.
Fifty consecutive patients were included from an outpatient heart failure (HF) clinic. Limited echocardiography was performed by 1 of 3 specialized nurses. The echocardiograms were transferred by a secure transfer model for near-real-time interpretation to 1 out-of-hospital cardiologist, assessing, among others, the left ventricular (LV) internal diameter, end-diastolic volume, ejection fraction, left atrial (LA) indexed end-systolic volume, mitral early inflow velocity (E), the ratio of E to mitral late inflow, and the ratio of E to the mitral annular early diastolic velocity. The reference method was echocardiography by 1 of 4 experienced cardiologists.
The median age of the population (46% women) was 79 (range, 33-95) years. The assessment and quantification of LA and LV dimensions, volumes, and functional indices were feasible in 94% or more via the telemedical approach. The agreement with reference measurements was very high by the telemedical approach. The mean duration ± SD of the complete telemedical approach from the start of echocardiography until the cardiologist's report was received by the caregiving nurse was 1.32 ± 0.36 (range, 1.58) hours. The correlations with reference to the above-specified indices were r = 0.75 to 0.94.
Limited echocardiography by nurses in an outpatient heart failure clinic, supported by interpretation by an out-of-hospital cardiologist, was feasible and reliable. This may reduce geographic disparities and allow more patients to benefit from the advantages of implementing focused echocardiography by noncardiologists in diagnostics and follow-up.
研究在经验丰富的心脏病专家通过远程医疗进行近实时解读支持下，护士进行心脏超声聚焦检查的可行性和准确性。
从门诊心力衰竭（HF）诊所连续纳入50例患者。由3名专业护士中的1名进行有限的超声心动图检查。超声心动图通过安全传输模型进行传输，以便由1名院外心脏病专家进行近实时解读，评估指标包括左心室（LV）内径、舒张末期容积、射血分数、左心房（LA）指数化收缩末期容积、二尖瓣早期血流速度（E）、E与二尖瓣晚期血流速度之比以及E与二尖瓣环舒张早期速度之比。参考方法是由4名经验丰富的心脏病专家中的1名进行超声心动图检查。
研究人群的中位年龄为79岁（范围33 - 95岁），女性占46%。通过远程医疗方法，对LA和LV的尺寸、容积及功能指标进行评估和量化的可行性达到94%或更高。远程医疗方法与参考测量值的一致性非常高。从超声心动图检查开始到护理护士收到心脏病专家报告的完整远程医疗方法的平均时长±标准差为1.32 ± 0.36（范围1.58）小时。与上述指定指标的相关性r = 0.75至0.94。
在门诊心力衰竭诊所，由护士进行有限的超声心动图检查，并得到院外心脏病专家的解读支持，是可行且可靠的。这可能减少地域差异，使更多患者能够从非心脏病专家实施心脏超声聚焦检查在诊断和随访中的优势中获益。
