This finding is in concordance with prior studies, indicating thateyeballing-EF eyeballing ejection fraction may be the most accurate echocardiographic method for the assessment of LV left ventricular systolic function. Since it is readily and quickly performed, eyeballing-EF eyeballing ejection fraction could be used for routine echocardiography instead of formal methods.

Background: Visual assessment of left ventricular ejection fraction (LVEF) is often used in clinical routine despite general recommendations to use quantitative biplane Simpsons (BPS) measurements. Even thou quantitative methods are well validated and from many reasons preferable, the feasibility of visual assessment (eyeballing) is superior. There is to date only sparse data comparing visual EF assessment in comparison to quantitative methods available. The aim of this study was to compare visual EF assessment by two-dimensional echocardiography (2DE) and triplane echocardiography (TPE) using quantitative real-time three-dimensional echocardiography (RT3DE) as the reference method.

IntroductionAssessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE).MethodsFifty patients with shock and mechanical ventilation were included. TTE examinations were performed daily for a total of 7 days. Methods used to assess LV systolic function were visually estimated, "eyeball" ejection fraction (EBEF), the Simpson single-plane method, mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs), and velocity time integral in the left ventricular outflow tract (VTI).ResultsEBEF, AVPDm, TDIs, VTI, and the Simpson were obtained in 100%, 100%, 99%, 95% and 93%, respectively, of all possible examinations. The correlations between the Simpson and EBEF showed r values for all 7 days ranging from 0.79 to 0.95 (P < 0.01). the Simpson correlations with the other LV parameters showed substantial variation over time, with the poorest results seen for TDIs and AVPDm. The repeatability was best for VTI (interobserver coefficient of variation (CV) 4.8%, and intraobserver CV, 3.1%), and AVPDm (5.3% and 4.4%, respectively), and worst for the Simpson method (8.2% and 10.6%, respectively).ConclusionsEBEF and AVPDm provided the best, and Simpson, the worst feasibility when assessing LV systolic function in a population of mechanically ventilated, hemodynamically unstable patients. Additionally, the Simpson showed the poorest repeatability. We suggest that EBEF can be used instead of single-plane Simpson when assessing LV ejection fraction in this category of patients. TDIs and AVPDm, as markers of longitudinal function of the LV, are not interchangeable with LV ejection fraction.

BackgroundAssessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common. The aim of this study was to investigate mitral annular plane systolic excursion (MAPSE) in critically ill patients with shock and its relation to LV systolic and diastolic function, myocardial injury and to outcome.MethodsIn a prospective, observational, cohort study we enrolled 50 patients with SIRS and shock despite fluid resuscitation. Transthoracic echocardiography (TTE) measuring LV function was performed within 12 hours after admission and daily for a 7-day observation period. TTE and laboratory measurements were related to 28-day mortality.ResultsMAPSE on day 1 correlated significantly with LV ejection fraction (LVEF), tissue Doppler indices of LV diastolic function (é, E/é) and high-sensitive troponin T (hsTNT) (p< 0.001, p= 0.039, p= 0.009, p= 0.003 respectively) whereas LVEF did not correlate significantly with any marker of LV diastolic function or myocardial injury. Compared to survivors, non-survivors had a significantly lower MAPSE (8 [IQR 7.5-11] versus 11 [IQR 8.9-13] mm; p= 0.028). Other univariate predictors were age (p=0.033), hsTNT (p=0.014) and Sequential Organ Failure Assessment (SOFA) scores (p=0.007). By multivariate analysis MAPSE (OR 0.6 (95% CI 0.5- 0.9), p= 0.015) and SOFA score (OR 1.6 (95% CI 1.1- 2.3), p= 0.018) were identified as independent predictors of mortality. Daily measurements showed that MAPSE, as sole echocardiographic marker, was significantly lower in most days in non-survivors (p<0.05 at day 1–2, 4–6).ConclusionsMAPSE seemed to reflect LV systolic and diastolic function as well as myocardial injury in critically ill patients with shock. The combination of MAPSE and SOFA added to the predictive value for 28-day mortality.

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This review maps patterns in research on Challenge Based Learning (CBL) in higher education (HE) between 2009 and 2020. How is CBL defined in HE settings? How is CBL in HE grounded scientifically in the research? The results show a shift of CBL from being a concept coined by a multinational technology company targeting learning in schools, to being embraced by HE, first and foremost as a method for transformation of adult learning. A critical scientifically grounded approach towards learning is however absent or marginally present in the papers reviewed. KEYWORDS Challenge-based learning; higher education; theories; adult learningToday CBL has moved into the HE sector (Johnson & Brown, 2011). In a guide from 2016, Nichols et al., include higher education when they state that 'Challenge Based Learning is an effective learning framework initiated at Apple, Inc. and used in universities, schools, and institutions around the world.' (Nichols et al. 2016, p.4).CBL draws from different educational theories, and pedagogical methods, for example, problem-based learning (PBL) and inquiry-based learning (IBL). PBL has been widely adopted in for example, medicine and engineering education, much because of the

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Background Left ventricular (LV) diastolic dysfunction has been associated with impaired glucometabolic status. However, studies of older subjects are lacking. We examined associations between echocardiographic indices of LV diastolic function and LV mass index (LVMI) and glucometabolic status among middle-aged and elderly subjects free from heart disease, hypothesizing that the associations would be comparative to younger cohorts. Methods We examined the AGES-RS (Iceland; n=607, 76±6 years) and MPP-RES cohorts (Sweden; n=1519, 67±6 years), evaluating associations with multivariable regression analysis. Results In AGES-RS, LVMI was positively correlated with HbA1c (p=0.001). Otherwise, echocardiographic variables were not associated with glucometabolic status. In MPP-RES, LVMI increased with increasing glucometabolic disturbance among both older (70–80 years) and middle-aged (57–69 years) subjects. Among older subjects, HbA1c was positively correlated with two variables reflecting LV diastolic function: late transmitral peak flow velocity (A) (p=0.001) and early transmitral peak flow velocity (E)/early diastolic peak tissue velocity (Em) (p=0.046). In middle-aged MPP-RES subjects, increasing glucometabolic disturbance was correlated with increasing late diastolic peak tissue velocity (Am) (p=0.002) and, after age-adjustment, with increasing A (p=0.001) and decreasing Em/Am (p=0.009). With age-adjustment, Am and A were positively correlated with fasting glucose and HbA1c. Conclusions Contrary to our hypothesis, in two independent cohorts of older individuals, associations between glucometabolic status and LV diastolic function were generally weak. This contrasts with previous reports, as well as with observations among middle-aged subjects in the present study. Changes in LV diastolic function may be more age-related than associated with glucose metabolism in older subjects.