Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.
Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
Echocardiography. 2022 Jul;39(7):886-894. doi: 10.1111/echo.15372. Epub 2022 Jun 6.
The association between COVID-19 infection and the cardiovascular system necessitates the use of an echocardiogram in this setting. Information on the utilization, safety, and quality of point-of-care cardiac and lung ultrasound using a hand-held device in these patients is scarce.
To investigate the safety, technical aspects, quality indices, and interpretive accuracy of a hand-held echocardiogram in patients with COVID-19.
From April-28 through July-27, 2020, consecutive patients with COVID-19 underwent hand-held echocardiogram and lung ultrasound evaluation (Vscan Extend™; GE Healthcare) within 48-h of admission. The operators recorded a series of technical parameters and graded individual experiences. The examinations were further analyzed by a blinded fellowship-trained echocardiographer for general quality, proper acquisition, and right ventricular (RV) demonstration.
Among 103 patients, 66 (64.1%) were male. Twenty-nine (28.2%) patients could not turn on their left side and 23 (22.3%) could not maintain effective communication. The mean length of each echocardiogram study was 8.5 ± 2.9 min, battery usage was 14 ± 5%, and mean operator-to-patient proximity was 59 ± 11 cm. Ninety-five (92.2%) examinations were graded as fair/good quality. A fair agreement was demonstrated between the operator and the echocardiographer for general ultrasound quality (Kappa = 0.329, p < 0.001). A fair-good correlation (r = 0.679, p < 0.001) and substantial agreement (Kappa = 0.612, p < 0.001) were demonstrated between the operator and echocardiographer for left ventricular ejection fraction (LVEF), whereas a fair agreement was demonstrated for RV systolic function (Kappa = 0.308, p = 0.002). LVEF agreement was also assessed using the Bland-Altman analysis revealing a mean bias of -0.96 (95% limits of agreement 9.43 to -11.35; p = 0.075).
Among patients with COVID-19, echocardiography with a hand-held ultrasound is a safe and reasonable alternative for a complete formal study (<10% poor-quality indices). Echocardiogram assessment by the operators during the exam acquisition is reliable for LVEF, while RV systolic function should be subsequently offline reassessed.
COVID-19 感染与心血管系统的关联需要在这种情况下使用超声心动图。有关在这些患者中使用手持式设备进行即时心脏和肺部超声的使用情况、安全性和质量信息很少。
研究手持式超声心动图在 COVID-19 患者中的安全性、技术方面、质量指标和解释准确性。
2020 年 4 月 28 日至 7 月 27 日，连续 103 例 COVID-19 患者在入院后 48 小时内行手持式超声心动图和肺部超声检查（Vscan Extend ™；GE Healthcare）。操作人员记录了一系列技术参数并对个人经验进行了分级。进一步由一名经过盲法培训的超声心动图研究员对一般质量、适当采集和右心室（RV）显示进行分析。
在 103 例患者中，66 例（64.1%）为男性。29 例（28.2%）患者无法向左侧翻身，23 例（22.3%）无法进行有效沟通。每个超声心动图研究的平均长度为 8.5 ± 2.9 分钟，电池使用率为 14 ± 5%，操作人员与患者的平均距离为 59 ± 11 厘米。95 例（92.2%）检查评为良好/一般质量。操作人员和超声心动图医师之间的一般超声质量显示出适度的一致性（Kappa = 0.329，p < 0.001）。操作人员和超声心动图医师之间的左心室射血分数（LVEF）显示出良好的相关性（r = 0.679，p < 0.001）和一致性（Kappa = 0.612，p < 0.001），而 RV 收缩功能则显示出良好的一致性（Kappa = 0.308，p = 0.002）。LVEF 一致性也通过 Bland-Altman 分析进行了评估，显示平均偏差为-0.96（95%置信区间为 9.43 至-11.35；p = 0.075）。
在 COVID-19 患者中，手持式超声心动图是一种安全合理的替代方法，可以进行完整的正式研究（<10%的质量指数较差）。在检查采集过程中，操作人员进行的超声心动图评估对于 LVEF 是可靠的，而 RV 收缩功能则应随后离线重新评估。
