Akil S, Castaings J, Thind P, Åhlfeldt T, Akhtar M, Gonon A T, Quintana M, Bouma K
Division of Laboratory Medicine, Department of Clinical Physiology, Karolinska Institute, Huddinge, Sweden.
Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
Clin Physiol Funct Imaging. 2025 Jan;45(1):e12918. doi: 10.1111/cpf.12918. Epub 2024 Dec 2.
In clinical routine, health care professionals with various levels of experience assess left ventricular ejection fraction (LVEF) by echocardiography. The aim was to investigate to what extent visual and Simpson's biplane assessment of LVEF, using two-dimensional (2D) transthoracic echocardiography (TTE), is affected by the evaluator's experience.
Ultrasound images of 140 patients were assessed, visually and with Simpson's biplane method, by six evaluators divided into three groups based on echocardiographic experience level (beginner, intermediate and expert). The evaluators were blinded to each other's LVEF assessments. Bland-Altman analyses (bias±SD) were performed to assess agreement. P-values < 0.05 with the performed paired t-test were considered statistically significant.
Level of agreement in LVEF was good between evaluators within the expert group: visual = LVEF vs LVEF: -0.4 ± 6.4 (p = 0.46); Simpson's biplane = LVEF vs LVEF: 0.96 ± 7.0 (p = 0.11), somewhat lower within the intermediate group: visual = LVEF vs LVEF: -1.2 ± 4.4 (p = 0.004); Simpson's biplane = LVEF vs LVEF : -3.3 ± 5.0 (p < 0.001) and lowest for beginners: visual = LVEF vs LVEF: 2.3 ± 9.8 (p = 0.007), Simpson's biplane = LVEF vs LVEF beginner 2: -1.8 ± 8.7 (p = 0.02). The agreement between LVEF and LVEFs by the two other groups was: visual = LVEF vs LVEF: 1.5 ± 6.0 (p = 0.005); LVEF: -3.0 ± 4.4 (p < 0.001) and Simpson's biplane = LVEF vs LVEF: 3.2 ± 6.3 (p < 0.001); LVEF: -2.2 ± 4.7 (p < 0.001).
The evaluator's level of experience affects visual and Simpson's biplane assessment of LVEF by 2D-TTE, with highest variability being among beginners. Furthermore, a second opinion is recommended when assessing reduced LVEF even for evaluators with intermediate and expert experience.
在临床实践中，不同经验水平的医护人员通过超声心动图评估左心室射血分数（LVEF）。本研究旨在探讨使用二维（2D）经胸超声心动图（TTE）对LVEF进行视觉评估和Simpson双平面评估受评估者经验影响的程度。
140例患者的超声图像由6名评估者进行视觉评估和Simpson双平面法评估，评估者根据超声心动图经验水平分为三组（初学者、中级和专家）。评估者对彼此的LVEF评估结果不知情。采用Bland-Altman分析（偏差±标准差）评估一致性。配对t检验的P值<0.05被认为具有统计学意义。
专家组内评估者之间LVEF的一致性良好：视觉评估=LVEF与LVEF：-0.4±6.4（p=0.46）；Simpson双平面评估=LVEF与LVEF：0.96±7.0（p=0.11）；中级组的一致性稍低：视觉评估=LVEF与LVEF：-1.2±4.4（p=0.004）；Simpson双平面评估=LVEF与LVEF：-3.3±5.0（p<0.001）；初学者的一致性最低：视觉评估=LVEF与LVEF：2.3±9.8（p=0.007），Simpson双平面评估=LVEF与初学者2：-1.8±8.7（p=0.02）。另外两组与LVEF之间的一致性为：视觉评估=LVEF与LVEF：1.5±6.0（p=0.005）；LVEF：-3.0±4.4（p<0.001）；Simpson双平面评估=LVEF与LVEF：3.2±6.3（p<0.001）；LVEF：-2.2±4.7（p<0.001）。
评估者的经验水平会影响2D-TTE对LVEF的视觉评估和Simpson双平面评估，初学者的变异性最高。此外，即使是具有中级和专家经验的评估者，在评估LVEF降低时也建议寻求第二种意见。
