AIM: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS: Consecutive patients, &...AIM: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS: Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images. Interobserver agreement of abdominal aortic size was determined by the correlation coefficient and paired t test. Interobserver reliability for each cardiologist was assessed using Bland-Altman plots. RESULTS: Ninety patients were studied. The mean age of patients was 72 ± 10 years and 48% were male. The mean aortic diameter was 2.31 ± 0.50 cm and 5 patients (5.5%) had an abdominal aortic aneurysm (AAA). The additional time required for the ab-dominal aortic images was 4.4 ± 0.9 min per patient. Interobserver agreement between the 2 cardiologist interpreters and the vascular medicine specialist was excellent (P > 0.05 for all comparisons). On Bland-Altman analysis ofinterobserver reliability, the 95% lower and upper limits for measurement by the cardiologists were 84% and 124% of that of the vascular specialist. CONCLUSION: The assessment of the abdominal aorta during a routine TTE performed by a cardiologist is accurate in comparison to that of a vascular medicine specialist. In selected patients undergoing TTE, the detection rate of AAA is significant. Additional time and effort required to perform imaging of the abdominal aorta after TTE is less than 5 min.展开更多
In a retrospective study of 1224 transthoracic echocardiograms performed between January 2011 and December 2013, we evaluated the spectrum of congenital heart disease (CHD) diagnosed at a tertiary referral centre in M...In a retrospective study of 1224 transthoracic echocardiograms performed between January 2011 and December 2013, we evaluated the spectrum of congenital heart disease (CHD) diagnosed at a tertiary referral centre in Maiduguri, north-eastern Nigeria. Diagnosis of CHD was made in 88 (8.3%) subjects, comprising 23 (26.1%) adults and 65 (73.9%) aged less than 18 years. Forty six (52.3%) of those with CHD were females, while 42 (47.7%) were males. The frequencies of the CHD in decreasing order were: ventricular septal defect 23 (26.1%), tetralogy of Fallot (TOF) 14 (15.9%) and atrial septal defect (ASD) and atrioventricular septal defect (AVSD) were 11 (12.5%) each. One of the patients with AVSD had Ellis Van Creveldt syndrome. Six (6.8%) cases of patent ductus arteriosus (PDA) were diagnosed in those younger than 18 years, while all the 5 (5.7%) cases of Ebstein’s anomaly were diagnosed in adults. There were 6 (6.8%) cases of Eisenmenger syndrome involving three cases of AVSD, one case of ASD and two cases of Ebstein’s anomaly. Timely definitive cares for these patients are still lacking in Nigeria and many areas of sub-Saharan Africa. We recommend sensitization of all relevant clinicians to actively look for congenital heart defects. Pulse oximetry and postnatal echocardiographic new-born screening which were previously validated should be implemented at secondary and tertiary levels, and efforts should be made towards providing the needed care for patients with CHD.展开更多
Objective This study aimed to determine which parameters in transthoracic echocardiography(TTE)are more likely to be affected when applied in a critical care setting with mechanical ventilation.Methods Ninety mechanic...Objective This study aimed to determine which parameters in transthoracic echocardiography(TTE)are more likely to be affected when applied in a critical care setting with mechanical ventilation.Methods Ninety mechanically ventilated ICU patients were enrolled into the study group.The control group consisted of 90 patients who underwent interventional therapy.All patients had bedside TTE for parametric measurements including the right ventricular size,septal kinetics and left ventricular ejection fraction(LVEF)by eyeballing(visual assessment),the tricuspid annular plane systolic excursion(TAPSE),mitral annular plane systolic excursion(MAPSE)by M-mode sonography,the right ventricular outflow tract velocity-time integral(RVOT VTI)and left ventricular outflow tract velocity-time integral(LVOT VTI)by pulse-Doppler,the right ventricular fraction of area change(FAC)and left ventricular ejection fraction(LVEF Simpson)by endocardium tracing.We compared the differences in the frequency of optimal image acquisition in assessments of these parameters between the two groups,as well as the differences in acquisition rates of parameter measurements in ventilated ICU patients.Results There were significantly fewer patients in the study group than in the control group who had optimal images acquisitions for parameter assessments with M-mode method,pulse Doppler method and endocardiumtracing method(P<0.05);no significant difference was obsered in the number of patients with optimal images for RV eyeballing and LVEF eyeballing between the two groups.In the study group,significantly fewer optimal images were acquired for FAC than forTAPSE(22.2%vs、72.2%,χ2=45.139,P<0.001)and RVOT VTI(22.2%vs.71.1%,χ2=43.214,P<0.001);there were also fewer optimal images acquired for LVEF Simpson than for MAPSE(37.8%ys.84.4%,χ2=41.236,P<0.001)and LVOT VTI(37.8%vs.85.6%,/=43.455,P<0.001).Conclusions Images acquisition of optimal TTE images tend to be difRcult in mechanically ventilated ICU patients,but eyeballing method for functional evaluation could be an alternative method.For quantitative parameters measurements,M-mode based longitudinal function evaluation and pulse Doppler-based VTI were superior to the endocardium-tracing based parameter assessments.展开更多
The clinical assessment of patients with respiratory and circulatory problems can be complex, time consuming and have a high incidence of error. Bedside transthoracic ultrasound (US) is a useful adjunctive test in the...The clinical assessment of patients with respiratory and circulatory problems can be complex, time consuming and have a high incidence of error. Bedside transthoracic ultrasound (US) is a useful adjunctive test in the evaluation of acutely unstable patients. This case series describes the use of the Focus Assessed Transthoracic Echocardiography (FATE) protocol to diagnose unsuspected pleural collections of fluid and how drainage significantly contributes to the haemodynamic improvement seen in these patients.展开更多
AIM: To investigate the utility of transthoracic echocardiography in confirming appropriate pulmonary artery catheter(PAC) placement. METHODS: Three commonly used transthoracic echocardiography(TTE) views were used to...AIM: To investigate the utility of transthoracic echocardiography in confirming appropriate pulmonary artery catheter(PAC) placement. METHODS: Three commonly used transthoracic echocardiography(TTE) views were used to confirm PAC position in 103 patients undergoing elective cardiac surgery- the parasternal short axis right ventricular inflow-outflow view; the subcostal short axis right ventricular inflow-outflow view; and the parasternal short axis ascending aortic view. All PACs were inserted by the managing anesthesiologist under pressure waveform guidance alone, who was blinded to all sonographic information. A sonographer blinded to all pressure waveform information confirmed visualisation of an "empty" PA before PAC insertion, and visualisation of the PAC balloon in the main PA(MPA) or right PA(RPA) after attempts at placement were complete. Agreement, sensitivity and specificity of TTE in confirming appropriate PAC placement was compared against pressure waveformguidance as the "gold standard". The successful view used was compared against patients' anthropomorphic indices, presence of lung hyperinflation, and insertion of PAC during positive pressure ventilation. Agreement between TTE and pressure waveform guidance was analysed using Cohen's Kappa statistic. The relative proportion of total RPA seen by subcostal vs parasternal TTE views was also compared with a further 20 patients' computed tomography(CT) pulmonary angiograms(CTPA), to determine efficacy in detection of distal RPA PAC placement. RESULTS: Appropriate positioning of the PAC balloon, and its to-and-fro movement consistent with a nonwedged state, within the MPA or RPA was confirmed by TTE in 98 of the 103 patients [sensitivity 95%(95%CI: 89%-98%)], and absence of the PAC balloon before insertion correctly established in 100 patients [specificity 97%(92%-99%)]. This was in very good agreement with pressure waveform guidance [Cohen's Kappa 0.92,(0.87-0.98)]. The subcostal view was the best view to visualise the PAC tip when it was placed in the right pulmonary artery(OR 70, P < 0.0001), was more successful in patients with COAD(OR 9.5, P = 0.001), and visualized 61%(vs 44% by parasternal views, P < 0.001) of mean RPA lengths compared with CTPA; however the parasternal views were more successful in patients with higher body mass indexs(OR 0.78 for success with subcostal views, P < 0.001). There was a trend towards insertion during intermittent positive pressure ventilation favoring visualisation by subcostal views(OR 3.9, P = 0.08). The subcostal view visualized a greater length of the RPA than parasternal views(3.9 cm vs 2.9 cm, P < 0.0001). PACs were more often placed in the MPA than RPA(80 vs 18 patients). Three patient's pulmonary arteries were not visible by any TTE view; in a further 2 patients, despite preinsertion visualisation of their pulmonary arteries, the PAC balloon was not visible by any view with TTE where correct placement by pressure waveform was unequivocal.展开更多
目的:观察经颅多普勒(ton crush day,TCD)发泡试验联合经胸超声心动图(transthoracic echocardiography,TTE)在诊断卵圆孔未闭(Patent Foramen Ovale,PFO)所致偏头痛及右向左分流(Right to left shunt,RLS)分级中的作用。方法:选取本院2...目的:观察经颅多普勒(ton crush day,TCD)发泡试验联合经胸超声心动图(transthoracic echocardiography,TTE)在诊断卵圆孔未闭(Patent Foramen Ovale,PFO)所致偏头痛及右向左分流(Right to left shunt,RLS)分级中的作用。方法:选取本院2019年2月-2020年2月收治的100例排除其它原因引发偏头痛患者设为研究对象,皆由经食管超声心动图(transesophageal echocardiography,TEE)检查确诊PFO所致偏头痛63例,均行TCD发泡试验以及TTE检查。比较TTE与TCD发泡试验检查灵敏度、特异度以及RLS分级。结果:TTE检查灵敏度为66.67%,特异度为86.49%,TTE和TEE检查检出率比较,差异具有统计学意义(P<0.05);TCD发泡试验检查灵敏度为80.95%,特异度为78.38%,TCD发泡试验和TEE检查检出率比较,无可比性(P<0.05)。TTE检查静息状态Ⅰ级(68.00%)、Ⅱ级(13.00%)、Ⅲ级(12.00%)、Ⅳ级(7.00%);Valsalva动作后Ⅰ级(53.00%)、Ⅱ级(21.00%)、Ⅲ级(16.00%)、Ⅳ级(10.00%);TTE检查Valsalva动作后阳性率高于静息状态,无统计学显著差异(P>0.05)。TCD发泡试验检查静息状态Ⅰ级(55.00%)、Ⅱ级(18.00%)、Ⅲ级(16.00%)、Ⅳ级(11.00%);Valsalva动作后Ⅰ级(41.00%)、Ⅱ级(24.00%)、Ⅲ级(20.00%)、Ⅳ级(15.00%)。TCD发泡试验检查Valsalva动作后阳性率高于静息状态,无统计学显著差异(P>0.05)。组间比较,皆无统计学显著差异(P>0.05)。结论:诊断PFO所致偏头痛在TTE基础上联合TCD发泡试验有效提高灵敏度与特异度,分流量分级更准确。展开更多
文摘AIM: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS: Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images. Interobserver agreement of abdominal aortic size was determined by the correlation coefficient and paired t test. Interobserver reliability for each cardiologist was assessed using Bland-Altman plots. RESULTS: Ninety patients were studied. The mean age of patients was 72 ± 10 years and 48% were male. The mean aortic diameter was 2.31 ± 0.50 cm and 5 patients (5.5%) had an abdominal aortic aneurysm (AAA). The additional time required for the ab-dominal aortic images was 4.4 ± 0.9 min per patient. Interobserver agreement between the 2 cardiologist interpreters and the vascular medicine specialist was excellent (P > 0.05 for all comparisons). On Bland-Altman analysis ofinterobserver reliability, the 95% lower and upper limits for measurement by the cardiologists were 84% and 124% of that of the vascular specialist. CONCLUSION: The assessment of the abdominal aorta during a routine TTE performed by a cardiologist is accurate in comparison to that of a vascular medicine specialist. In selected patients undergoing TTE, the detection rate of AAA is significant. Additional time and effort required to perform imaging of the abdominal aorta after TTE is less than 5 min.
文摘In a retrospective study of 1224 transthoracic echocardiograms performed between January 2011 and December 2013, we evaluated the spectrum of congenital heart disease (CHD) diagnosed at a tertiary referral centre in Maiduguri, north-eastern Nigeria. Diagnosis of CHD was made in 88 (8.3%) subjects, comprising 23 (26.1%) adults and 65 (73.9%) aged less than 18 years. Forty six (52.3%) of those with CHD were females, while 42 (47.7%) were males. The frequencies of the CHD in decreasing order were: ventricular septal defect 23 (26.1%), tetralogy of Fallot (TOF) 14 (15.9%) and atrial septal defect (ASD) and atrioventricular septal defect (AVSD) were 11 (12.5%) each. One of the patients with AVSD had Ellis Van Creveldt syndrome. Six (6.8%) cases of patent ductus arteriosus (PDA) were diagnosed in those younger than 18 years, while all the 5 (5.7%) cases of Ebstein’s anomaly were diagnosed in adults. There were 6 (6.8%) cases of Eisenmenger syndrome involving three cases of AVSD, one case of ASD and two cases of Ebstein’s anomaly. Timely definitive cares for these patients are still lacking in Nigeria and many areas of sub-Saharan Africa. We recommend sensitization of all relevant clinicians to actively look for congenital heart defects. Pulse oximetry and postnatal echocardiographic new-born screening which were previously validated should be implemented at secondary and tertiary levels, and efforts should be made towards providing the needed care for patients with CHD.
文摘Objective This study aimed to determine which parameters in transthoracic echocardiography(TTE)are more likely to be affected when applied in a critical care setting with mechanical ventilation.Methods Ninety mechanically ventilated ICU patients were enrolled into the study group.The control group consisted of 90 patients who underwent interventional therapy.All patients had bedside TTE for parametric measurements including the right ventricular size,septal kinetics and left ventricular ejection fraction(LVEF)by eyeballing(visual assessment),the tricuspid annular plane systolic excursion(TAPSE),mitral annular plane systolic excursion(MAPSE)by M-mode sonography,the right ventricular outflow tract velocity-time integral(RVOT VTI)and left ventricular outflow tract velocity-time integral(LVOT VTI)by pulse-Doppler,the right ventricular fraction of area change(FAC)and left ventricular ejection fraction(LVEF Simpson)by endocardium tracing.We compared the differences in the frequency of optimal image acquisition in assessments of these parameters between the two groups,as well as the differences in acquisition rates of parameter measurements in ventilated ICU patients.Results There were significantly fewer patients in the study group than in the control group who had optimal images acquisitions for parameter assessments with M-mode method,pulse Doppler method and endocardiumtracing method(P<0.05);no significant difference was obsered in the number of patients with optimal images for RV eyeballing and LVEF eyeballing between the two groups.In the study group,significantly fewer optimal images were acquired for FAC than forTAPSE(22.2%vs、72.2%,χ2=45.139,P<0.001)and RVOT VTI(22.2%vs.71.1%,χ2=43.214,P<0.001);there were also fewer optimal images acquired for LVEF Simpson than for MAPSE(37.8%ys.84.4%,χ2=41.236,P<0.001)and LVOT VTI(37.8%vs.85.6%,/=43.455,P<0.001).Conclusions Images acquisition of optimal TTE images tend to be difRcult in mechanically ventilated ICU patients,but eyeballing method for functional evaluation could be an alternative method.For quantitative parameters measurements,M-mode based longitudinal function evaluation and pulse Doppler-based VTI were superior to the endocardium-tracing based parameter assessments.
文摘The clinical assessment of patients with respiratory and circulatory problems can be complex, time consuming and have a high incidence of error. Bedside transthoracic ultrasound (US) is a useful adjunctive test in the evaluation of acutely unstable patients. This case series describes the use of the Focus Assessed Transthoracic Echocardiography (FATE) protocol to diagnose unsuspected pleural collections of fluid and how drainage significantly contributes to the haemodynamic improvement seen in these patients.
文摘AIM: To investigate the utility of transthoracic echocardiography in confirming appropriate pulmonary artery catheter(PAC) placement. METHODS: Three commonly used transthoracic echocardiography(TTE) views were used to confirm PAC position in 103 patients undergoing elective cardiac surgery- the parasternal short axis right ventricular inflow-outflow view; the subcostal short axis right ventricular inflow-outflow view; and the parasternal short axis ascending aortic view. All PACs were inserted by the managing anesthesiologist under pressure waveform guidance alone, who was blinded to all sonographic information. A sonographer blinded to all pressure waveform information confirmed visualisation of an "empty" PA before PAC insertion, and visualisation of the PAC balloon in the main PA(MPA) or right PA(RPA) after attempts at placement were complete. Agreement, sensitivity and specificity of TTE in confirming appropriate PAC placement was compared against pressure waveformguidance as the "gold standard". The successful view used was compared against patients' anthropomorphic indices, presence of lung hyperinflation, and insertion of PAC during positive pressure ventilation. Agreement between TTE and pressure waveform guidance was analysed using Cohen's Kappa statistic. The relative proportion of total RPA seen by subcostal vs parasternal TTE views was also compared with a further 20 patients' computed tomography(CT) pulmonary angiograms(CTPA), to determine efficacy in detection of distal RPA PAC placement. RESULTS: Appropriate positioning of the PAC balloon, and its to-and-fro movement consistent with a nonwedged state, within the MPA or RPA was confirmed by TTE in 98 of the 103 patients [sensitivity 95%(95%CI: 89%-98%)], and absence of the PAC balloon before insertion correctly established in 100 patients [specificity 97%(92%-99%)]. This was in very good agreement with pressure waveform guidance [Cohen's Kappa 0.92,(0.87-0.98)]. The subcostal view was the best view to visualise the PAC tip when it was placed in the right pulmonary artery(OR 70, P < 0.0001), was more successful in patients with COAD(OR 9.5, P = 0.001), and visualized 61%(vs 44% by parasternal views, P < 0.001) of mean RPA lengths compared with CTPA; however the parasternal views were more successful in patients with higher body mass indexs(OR 0.78 for success with subcostal views, P < 0.001). There was a trend towards insertion during intermittent positive pressure ventilation favoring visualisation by subcostal views(OR 3.9, P = 0.08). The subcostal view visualized a greater length of the RPA than parasternal views(3.9 cm vs 2.9 cm, P < 0.0001). PACs were more often placed in the MPA than RPA(80 vs 18 patients). Three patient's pulmonary arteries were not visible by any TTE view; in a further 2 patients, despite preinsertion visualisation of their pulmonary arteries, the PAC balloon was not visible by any view with TTE where correct placement by pressure waveform was unequivocal.
文摘目的 麻醉专业住院医师规范化培训期间使用TIE模拟器行经胸超声心动（TTE）培训是否较传统视频授课效果更好.方法 用两种授课方法进行前瞻性随机对照研究,将42名麻醉专业住院医师（1～3年级）随机分为对照组（视频授课）（n=21）和试验组（TTE模拟器授课）（n=21）.授课前行笔试（时间45 min）.效果评估采用课后笔试及志愿者实体TTE操作考核.操作考核包括获取正确图像及质量、解剖结构识别、获取正确图像所需时间.结果 培训前笔试分数无统计学差异.培训后测试结果试验组优于对照组：培训后笔试（43.3％±10.8％ vs 52.6％±17.6％,P＜0.05）,操作考核获取正确图像质量（0～25分）（7.7±5.1 vs 17.1 ±4.8,P＜0.001）,解剖结构识别（0 ～ 25分）（11.0±7.3 vs 18.2±6.3;P=0.001）.结论 表明麻醉专业规范化培训期间TTE培训中,TTE模拟器与传统视频授课相比,前者可以使住院医师更好的掌握实际操作TTE图像获取技术及解剖结构识别.
文摘目的:观察经颅多普勒(ton crush day,TCD)发泡试验联合经胸超声心动图(transthoracic echocardiography,TTE)在诊断卵圆孔未闭(Patent Foramen Ovale,PFO)所致偏头痛及右向左分流(Right to left shunt,RLS)分级中的作用。方法:选取本院2019年2月-2020年2月收治的100例排除其它原因引发偏头痛患者设为研究对象,皆由经食管超声心动图(transesophageal echocardiography,TEE)检查确诊PFO所致偏头痛63例,均行TCD发泡试验以及TTE检查。比较TTE与TCD发泡试验检查灵敏度、特异度以及RLS分级。结果:TTE检查灵敏度为66.67%,特异度为86.49%,TTE和TEE检查检出率比较,差异具有统计学意义(P<0.05);TCD发泡试验检查灵敏度为80.95%,特异度为78.38%,TCD发泡试验和TEE检查检出率比较,无可比性(P<0.05)。TTE检查静息状态Ⅰ级(68.00%)、Ⅱ级(13.00%)、Ⅲ级(12.00%)、Ⅳ级(7.00%);Valsalva动作后Ⅰ级(53.00%)、Ⅱ级(21.00%)、Ⅲ级(16.00%)、Ⅳ级(10.00%);TTE检查Valsalva动作后阳性率高于静息状态,无统计学显著差异(P>0.05)。TCD发泡试验检查静息状态Ⅰ级(55.00%)、Ⅱ级(18.00%)、Ⅲ级(16.00%)、Ⅳ级(11.00%);Valsalva动作后Ⅰ级(41.00%)、Ⅱ级(24.00%)、Ⅲ级(20.00%)、Ⅳ级(15.00%)。TCD发泡试验检查Valsalva动作后阳性率高于静息状态,无统计学显著差异(P>0.05)。组间比较,皆无统计学显著差异(P>0.05)。结论:诊断PFO所致偏头痛在TTE基础上联合TCD发泡试验有效提高灵敏度与特异度,分流量分级更准确。
