Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada.
Centre de Rercherche de l'Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada.
BMC Cardiovasc Disord. 2023 Mar 8;23(1):115. doi: 10.1186/s12872-023-03141-x.
There is a need for a convenient, yet reliable method to assess left ventricular ejection fraction (LVEF) with point-of-care ultrasound study (POCUS). We aim to validate a novel and simplified wall motion score LVEF based on the analysis of a simplified combination of echocardiographic views.
In this retrospective study, transthoracic echocardiograms of randomly selected patients were analysed by the standard 16-segments wall motion score index (WMSI) to derive the reference semi-quantitative LVEF. To develop our semi-quantitative simplified-views method, a limited combination of imaging views and only 4 segments per view were tested: (1) A combination of the three parasternal short-axis views (PSAX BASE, MID-, APEX); (2) A combination of the three apical views (apical 2-chamber, 3-chamber and 4-chamber) and (3) A more limited combination of PSAX-MID and apical 4-chamber is called the MID-4CH. Global LVEF is obtained by averaging segmental EF based on contractility (normal = 60%, hypokinesia = 40%, and akinesia = 10%). Accuracy of the novel semi-quantitative simplified-views WMS method compared to the reference WMSI was evaluated using Bland-Altman analysis and correlation was assessed in both emergency physicians and cardiologists.
In the 46 patients using the 16 segments WMSI method, the mean LVEF was 34 ± 10%. Among the three combinations of the two or three imaging views analysed, the MID-4CH had the best correlation with the reference method (r = 0.90) with very good agreement (mean LVEF bias = - 0.2%) and precision (± 3.3%).
Cardiac POCUS by emergency physicians and other non-cardiologists is a decisive therapeutic and prognostic tool. A simplified semi-quantitative WMS method to assess LVEF using the easiest technically achievable combination of mid-parasternal and apical four-chamber views provides a good approximative estimate for both non-cardiologist emergency physicians and cardiologists.
需要一种方便且可靠的方法，通过即时护理超声检查（POCUS）来评估左心室射血分数（LVEF）。我们旨在验证一种新的简化壁运动评分 LVEF，该方法基于对简化的超声心动图视图组合的分析。
在这项回顾性研究中，通过标准的 16 节段壁运动评分指数（WMSI）对随机选择的患者的经胸超声心动图进行分析，以得出参考半定量 LVEF。为了开发我们的半定量简化视图方法，我们测试了仅 4 个节段/视图的有限成像视图组合：（1）三个胸骨旁短轴视图（PSAX BASE、MID、APEX）的组合；（2）三个心尖视图（心尖 2 腔、3 腔和 4 腔）的组合和（3）称为 MID-4CH 的 PSAX-MID 和心尖 4 腔的更有限组合。通过基于收缩性的节段 EF 的平均值获得整体 LVEF（正常=60%，运动低下=40%，无运动=10%）。使用 Bland-Altman 分析评估新型半定量简化视图 WMS 方法与参考 WMSI 的准确性，并在急诊医师和心脏病专家中评估相关性。
在使用 16 节段 WMSI 方法的 46 名患者中，平均 LVEF 为 34±10%。在分析的两种或三种成像视图的三种组合中，MID-4CH 与参考方法相关性最好（r=0.90），具有很好的一致性（平均 LVEF 偏差=−0.2%）和精度（±3.3%）。
急诊医师和其他非心脏病专家的心脏 POCUS 是一种决定性的治疗和预后工具。使用最容易获得的中胸骨旁和心尖四腔视图的简化半定量 WMS 方法评估 LVEF，可以为非心脏病专家的急诊医师和心脏病专家提供良好的近似估计。
