Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Cardiac Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Makunda Christian Leprosy and General Hospital, Assam, India.
J Am Soc Echocardiogr. 2022 Dec;35(12):1281-1294. doi: 10.1016/j.echo.2022.07.014. Epub 2022 Aug 5.
Cardiac complications are a leading cause of maternal death. Cardiac imaging with echocardiography is important for prompt diagnosis, but it is not available in many low-resource settings. The aim of this study was to determine whether focused cardiac ultrasound performed by trained obstetricians and interpreted remotely by experts can identify cardiac abnormalities in pregnant women in low-resource settings.
A cross-sectional study was conducted among 301 pregnant and postpartum women recruited from 10 hospitals across three states in India. Twenty-two obstetricians were trained in image acquisition using a portable cardiac ultrasound device following a simplified protocol adapted from focus-assessed transthoracic echocardiography protocol. It included parasternal long-axis, parasternal short-axis, and apical four-chamber views on two-dimensional and color Doppler. Independent image interpretation was performed remotely by two experts, in the United Kingdom and India, using a standard semiquantitative assessment protocol. Interrater agreement between the experts was examined using Cohen's κ. Diagnostic accuracy of the method was examined in a subsample for whom both focused and conventional scans were available.
Cardiac abnormalities identified using the focused method included valvular abnormalities (27%), rheumatic heart disease (6.6%), derangements in left ventricular size (4.7%) and function (22%), atrial dilatation (19.5%), and pericardial effusion (30%). There was substantial agreement on the cardiac parameters between the two experts, ranging from 93.6% (κ = 0.84) for left ventricular ejection fraction to 100% (κ = 1) for valvular disease. Image quality was graded as good in 79% of parasternal long-axis, 77% of parasternal short-axis and 64% of apical four-chamber views. The chance-corrected κ coefficients indicated fair to moderate agreement (κ = 0.28-0.51) for the image quality parameters. There was good agreement on diagnosis between the focused method and standard echocardiography (78% agreement), compared in 36 participants.
The focused method accurately identified cardiac abnormalities in pregnant women and could be used for screening cardiac problems in obstetric settings.
心脏并发症是导致产妇死亡的主要原因。心脏影像学检查（如超声心动图）对于快速诊断至关重要，但在许多资源匮乏的环境中无法获得。本研究旨在确定经过培训的产科医生在资源匮乏环境中使用便携式心脏超声设备进行的心脏超声检查（简称“聚焦超声”）能否识别出孕妇的心脏异常。
本研究为横断面研究，共纳入来自印度三个邦的 10 家医院的 301 例妊娠和产后女性。22 名产科医生接受了使用简化协议获取图像的培训，该协议改编自焦点评估经胸超声心动图协议，包括二维和彩色多普勒的胸骨旁长轴、胸骨旁短轴和心尖四腔切面。两名专家在英国和印度远程进行独立的图像解读，使用标准的半定量评估协议。使用 Cohen's κ 检验评估专家间的组内一致性。在可同时获取聚焦超声和常规超声的亚组中，评估该方法的诊断准确性。
使用聚焦超声方法识别的心脏异常包括瓣膜异常（27%）、风湿性心脏病（6.6%）、左心室大小（4.7%）和功能（22%）异常、心房扩张（19.5%）和心包积液（30%）。两位专家在心脏参数方面具有高度一致性，左心室射血分数的一致性为 93.6%（κ=0.84），瓣膜疾病的一致性为 100%（κ=1）。79%的胸骨旁长轴、77%的胸骨旁短轴和 64%的心尖四腔切面的图像质量被评为良好。图像质量参数的校正后κ系数表明一致性为中等至良好（κ=0.28-0.51）。在 36 名参与者中，与标准超声心动图相比，聚焦超声法的诊断一致性为 78%。
聚焦超声法能准确识别孕妇的心脏异常，可用于筛查产科环境中的心脏问题。
