Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan.
J Echocardiogr. 2022 Mar;20(1):16-23. doi: 10.1007/s12574-021-00542-9. Epub 2021 Aug 4.
Echocardiography is a first-line tool for the screening of patients with cardiac dysfunction. However, the mastery of echocardiography requires significant training, and not all medical teams involve an echocardiography specialist. Telemedicine approaches can potentially improve the quality of echocardiography in resource-limited situations.
We used a novel tablet-based hand-held ultrasound device that enables tele-ultrasound- a real-time video telecommunication with remote control for ultrasound images. A trainee scanned patients with various cardiovascular diseases and interpreted the images. Subsequently, the same trainee re-scanned the same patients and re-interpreted the same images using tele-ultrasound with an echocardiography specialist. An examination on the same patients by a blinded specialist was considered the gold standard.
We included 31 patients (median 77 [interquartile range 68-84] years old, 42% women). Mean absolute errors in left ventricular (LV) end-diastolic and end-systolic diameters, visual LV ejection fraction, and tricuspid annular plane systolic excursion decreased significantly after tele-ultrasound advice (5.9 mm, 5.8 mm, 8.6%, and 4.5 to 1.6 mm, 2.8 mm, 0.7%, and 1.8 mm, respectively, all p < 0.001), and intra-class correlation coefficients improved (0.76, 0.84, 0.68, and 0.44 to 0.96, 0.93, 0.99, and 0.90, respectively). Notably, with tele-advice, the trainee's examination showed perfect agreement with that of the specialist in classifying LV ejection fraction (> 50%, 50-35%, or > 35%) and identifying significant valvular heart diseases.
Real-time tele-ultrasound improved a trainee's echocardiography results to those of a specialist-level examination. This approach might be helpful in resource-limited medical teams where echocardiographic specialists are not readily available.
超声心动图是筛查心功能障碍患者的一线工具。然而，掌握超声心动图需要大量的培训，并非所有医疗团队都有超声心动图专家。远程医疗方法可能会提高资源有限情况下的超声心动图质量。
我们使用了一种新型基于平板电脑的手持式超声设备，该设备能够实现远程超声——实时视频远程控制超声图像。一名学员对各种心血管疾病患者进行了扫描并对图像进行了判读。随后，同一名学员使用超声心动图专家的远程超声对同一患者再次进行扫描和判读。由一名盲法专家对同一患者进行的检查被认为是金标准。
我们纳入了 31 名患者（中位年龄 77 [四分位距 68-84]岁，42%为女性）。左心室（LV）舒张末期和收缩末期直径、视觉 LV 射血分数和三尖瓣环平面收缩期位移的平均绝对误差在接受远程超声建议后显著降低（分别为 5.9mm、5.8mm、8.6%和 4.5 至 1.6mm、2.8mm、0.7%和 1.8mm，均 p<0.001），且组内相关系数提高（分别为 0.76、0.84、0.68 和 0.44 至 0.96、0.93、0.99 和 0.90）。值得注意的是，在接受远程建议后，学员的检查在心功能分级（>50%、50-35%或>35%）和识别严重瓣膜性心脏病方面与专家检查具有完美的一致性。
实时远程超声可改善学员的超声心动图结果，使其达到专家级检查水平。在缺乏超声心动图专家的资源有限的医疗团队中，这种方法可能会有所帮助。
