Left ventricular ejection fraction assessment by non-cardiologists from transverse views using a simplified wall motion score index

Abstract

For the non-cardiologist emergency physician and intensivist, performing an accurate estimation of left ventricular ejection fraction (LVEF) is essential for the management of critically ill patients, such as patients presenting with shock, severe respiratory distress or chest pain. Our objective was to develop a semi-quantitative method to improve visual LVEF evaluation. A group of 12 sets of transthoracic echocardiograms with LVEF in the range of 18–64% were interpreted by 17 experienced observers (PRO) and 103 untrained observers or novices (NOV), without previous training in echocardiography. They were asked to assess LVEF by two different methods: i) visual estimation (VIS) by analysing the three classical left ventricle (LV) short-axis views (basal, midventricular and apical short-axis LV section) and ii) semi-quantitative evaluation (base, mid and apex (BMA)) of the same three short-axis views. The results for each of these two methods for both groups (PRO and NOV) were compared with LVEF obtained by radionuclide angiography. The semi-quantitative method (BMA) improved estimation of LVEF by PRO for moderate LV dysfunction (LVEF 30–49%) and normal LVEF. The visual estimate was better for lower LVEF (<30%). In the NOV group, the semi-quantitative method was better than than the visual one in the normal group and in half of the subjects in the moderate LV dysfunction (LVEF 30–49%) group. The visual estimate was better for the lower LVEF (ejection fraction <30%) group. In conclusion, semi-quantitative evaluation of LVEF gives an overall better assessment than VIS for PRO and untrained observers.

Feasibility of cardiac output measurements in critically ill patients by medical students

“…A number of previous studies employed training curricula for medical students on ultrasonography protocols [37][38][39]. Four other studies used a point-of-care ultrasonography training program to determine diagnostic performance in various clinical scenarios [36,[40][41][42]. All studies showed feasibility to train medical students to perform ultrasonography after a relatively short amount of training, which is comparable to the training medical students received in our study.…”

“…The studies reporting on image quality showed percentages of (at least) adequate imaging ranging from 89 to 98%, unfortunately by non-independent judging [3,7]. Furthermore, after training, medical students can adequately interpret images with a very simplified or binary assessment [36]. A number of previous studies employed training curricula for medical students on ultrasonography protocols [37][38][39].…”

Assessment of LVEF using a new 16-segment wall motion score in echocardiography

“…We have previously shown that a semi-quantitative method dedicated specifically to emergency and critical care physicians based on the simple assessment of normokinesia (EF = 60%), hypokinesia (EF = 40%) or akinesia (EF = 20%) in the 3 short-axis views was superior to global visual estimation ( 20 , 21 ). In the current study, we applied the new segmental EF 15-40-65 score in TTE to each of the 16 segments of the polar map and obtained a global LVEF resulting from the arithmetic mean of all segmental EF.…”

Left ventricular outflow tract pseudoaneurysm diagnosed with point-of-care ultrasound in the emergency department

“…13 As emergency physicians become more experienced with cardiac POCUS, more advanced applications are being investigated such as valvular assessment, regional wall motion, and diastolic function. [14][15][16] As a consequence of this increased experience with cardiac POCUS, emergency physicians may be able to identify if the heart does not appear normal because of other important cardiac abnormalities. In this case, the emergency physician identified a structural cardiac abnormality using POCUS that led to the request for an expedited inpatient workup.…”