School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Ultrasonography, Public Health Clinical Center of Chengdu, Chengdu, China.
Echocardiography. 2021 Aug;38(8):1245-1253. doi: 10.1111/echo.15124. Epub 2021 May 31.
The aim of this study was to evaluate the clinical significance of remote consultation over bedside transthoracic echocardiography (RC-B-TTE) for patients with coronavirus disease 2019 (COVID-19).
Five frontline echocardiographers performed and interpreted B-TTE for 30 patients with COVID-19 in the isolation wards, and the on-site B-TTE reports (OSR) were generated. Then remote consultation over the 30 B-TTE studies was conducted by two experienced echocardiographic consultants while blinded to the OSR, and the corresponding remote consultation reports (RCR) were generated. Subsequently, the five frontline echocardiographers were convened together to discuss the difference between the OSR and RCR, and to confirm the correct interpretation and the misdiagnosis using a "majority-vote" consensus as the diagnostic "gold standard". Afterwards the reasons for the misdiagnosis were given by the frontline echocardiographers themselves. The inter-rater agreement between the OSR and the "gold standard" was assessed using Kappa coefficient and percent agreement.
Complete correctness of the 30 copies of the RCR were determined by the 5 frontline echocardiographers. The reliability of the OSR in the findings of cardiac chamber dilation, left ventricular hypertrophy and pulmonary hypertension were weak (Kappa <0.6). The reliability of the OSR in the recognition of major cardiac abnormalities was very weak (Kappa =0.304, percent agreement =63.3%). Misdiagnosis of major abnormalities was found in 11 copies of OSR (11/30, 36.7%).
The protocol of RC-B-TTE has shown noticeable superiority in ameliorating diagnostic accuracy of echocardiography, which should be generalized to clinical practice during the COVID-19 or similar pandemic.
本研究旨在评估远程床旁经胸超声心动图（RC-B-TTE）会诊对 2019 年冠状病毒病（COVID-19）患者的临床意义。
5 名一线超声心动图医师对隔离病房的 30 名 COVID-19 患者进行了经胸超声心动图检查并进行了解读，生成了现场经胸超声心动图报告（OSR）。然后，由两名经验丰富的超声心动图顾问对 30 项经胸超声心动图研究进行远程会诊，同时对 OSR 进行盲法评估，生成相应的远程会诊报告（RCR）。随后，召集 5 名一线超声心动图医师对 OSR 和 RCR 的差异进行讨论，并采用“多数表决”共识作为诊断“金标准”来确认正确的解读和误诊。之后，由一线超声心动图医师自行给出误诊的原因。采用 Kappa 系数和百分比一致性评估 OSR 与“金标准”之间的组内一致性。
5 名一线超声心动图医师确定了 30 份 RCR 的完全正确性。OSR 在心脏腔室扩张、左心室肥厚和肺动脉高压等发现方面的可靠性较弱（Kappa<0.6）。OSR 在识别主要心脏异常方面的可靠性非常弱（Kappa=0.304，百分比一致性=63.3%）。在 11 份 OSR（11/30，36.7%）中发现了主要异常的误诊。
RC-B-TTE 方案在提高超声心动图诊断准确性方面具有显著优势，在 COVID-19 或类似大流行期间应推广到临床实践中。
