Physicians’ Ability to Visually Estimate Left Ventricular Ejection Fraction, Right Ventricular Enlargement, and Paradoxical Septal Motion After a 2-Day Focused Cardiac Ultrasound Training Course

Zhang, Hongmin; He, Wei; Wang, Xiaoting; Chao, Yangong; Zhang, Lina; Zhu, Ran; Yin, Wei Hsian; Liu, Lixia; Wu, Jun

doi:10.1053/j.jvca.2018.10.019

Cited by 6 publications

(7 citation statements)

References 22 publications

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“…However, their participants were all credentialed sonographers who could be expected be able to acquire this skill more rapidly than ultrasound beginners. Our previous study also found that ICU physicians obtained higher scores on images with poor LVEF during an image interpretation test, possibly because the different categories of LVEF, which were displayed on the same test, could be seen as a reference [12]. Hope et al found that even untrained medical students could make acceptable LVEF estimations if they were provided an image reference [26].…”

Section: Discussionmentioning

confidence: 81%

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Physicians’ abilities to obtain and interpret focused cardiac ultrasound images from critically ill patients after a 2-day training course

Zhang

Lian

et al. 2020

BMC Cardiovasc Disord

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Background: This study aimed to determine whether a focused 2-day cardiac ultrasound training course could enable physicians to obtain and interpret focused cardiac ultrasound (FCU) images from critically ill patients. Methods: We retrospectively reviewed the FCU images submitted by the physicians who attended a 2-day FCU training courses. Three experienced trainers reviewed the images separately. They determined whether the images were assessable and scored the images on an 8-point scale. They also decided whether the physicians provided correct responses for visual estimations of the left ventricular ejection fraction (LVEF) and right ventricle (RV) dilatation and septal motion. Results: Among the 327 physicians, 291 obtained images that were considered assessable (89%). The scores for parasternal short-axis view were lower than those obtained for other transthoracic echocardiographic views, p < 0.001. More physicians provided incorrect appraisals of LVEF than of RV dilatation and septal motion (19.9% vs. 3.1%, p < 0.001). The percentages of incorrect answers by LVEF category were as follows: 34.8% on images of LVEF < 30, 24.7% on images of LVEF 30-54, and 16.4% on images of LVEF ≥55%, p < 0.001. A logistic regression analysis showed that patients with abnormal LVEF were associated with physicians' incorrect assessment of LVEF, with an odds ratio of 1.923 (95% confidence interval (CI):1.071-3.456, p = 0.029). Conclusions: A large proportion of physicians could obtain and interpret FCU images from critically ill patients after a 2-day training course. However, they still scored low on the parasternal short-axis view and were more likely to make an incorrect assessment of LVEF in patients with abnormal left ventricular systolic function.

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Section: Discussionmentioning

confidence: 81%

“…Fifty images, portraying various levels of LVEF and RV enlargement and paradoxical septal motion, were reviewed in an interactive manner during the image interpretation session. The details of the training course were described in a previous study [12].…”

Section: Fcu Training and The Post-training Assignmentmentioning

confidence: 99%

Physicians’ abilities to obtain and interpret focused cardiac ultrasound images from critically ill patients after a 2-day training course

Zhang

Lian

et al. 2020

BMC Cardiovasc Disord

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“…8 The performance of certain number of FCU exam- Literature on the teachability of the visual assessment of the RV is sparse, but some studies report encouraging findings, especially when structured curricula come into use. 17…”

Section: Discussionmentioning

confidence: 99%

A one‐day focused cardiac ultrasound training has a limited impact on residents’ abilities to visually assess right ventricular dimensions and function

et al. 2022

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Background Focused cardiac ultrasound (FCU) is a helpful tool to rapidly identify right ventricular (RV) causes of hemodynamic instability and facilitate the initiation of therapy. The clinical value of existing course models often remains unclear. This study investigated the effects of a one‐day FCU training on the visual estimation skills of RV characteristics. Methods Four residents were included as the study group after completing a standardized one‐day FCU training. Four gender‐matched controls did not take part in the training. All residents graded image quality, RV systolic function, and RV dimensions in a test comprising 35 ultrasound clips. Results The study and control group did not differ in ICU or ultrasound experience. Overall, training participants were able to distinguish between good and insufficient image quality significantly better than the control group (agreement 80.0% vs 61.4%, p = 0.04). The agreement for the estimation of RV function and RV dimensions was not different between the groups (63.2% vs 60.5%, p = 0.66 and 64.3% vs 67.1%, p = 0.18, respectively). Descriptively, only small differences were found between the groups for the estimation of RV function and RV dimensions in subgroups of patients with normal versus reduced systolic RV function or normal versus enlarged RV dimensions, respectively. Both groups struggled in identifying RV enlargement (34.6% vs 46.2%). Discussion In this study, a single one‐day FCU training had no impact on residents’ skills to visually assess systolic RV function or RV dimensions. Improvements of current training modalities or continuous teaching models are needed to optimize residency programs and patient care.

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“…[10][11][12][13] Visual estimation techniques, however, suffer from significant interobserver variability and may yield agreement as low as 50% even in the hands of experienced echocardiographers. 6 The addition of quantitative LVEF assessment with the Simpson biplane method of discs was shown to improve diagnostic accuracy in a cohort of critical care physicians, 14 but the positive impact of incorporating this technique into an anesthesiology residency curriculum has never been studied.…”

Section: Despitementioning

confidence: 99%

“…[10][11][12][13] The improvement in image interpretation was most pronounced in images representing extremes of systolic function. 10,14 Although it is the cornerstone of current cardiac ultrasound education, qualitative assessment of LVEF has been shown to be less accurate and less reproducible than quantitative assessment by the biplane method of discs or modified Simpson's rule. 15 The efficacy of teaching quantitative methods of LVEF and the incorporation of these techniques into a curriculum has not been explored in studies of anesthesiology resident education.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Echocardiography Improves Resident Assessment of Left Ventricular Systolic Function

2022

JEPM

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Background: The use of echocardiography to assess left ventricular ejection fraction (LVEF) is an important component of anesthesiology resident education; however, there is no consensus on the most effective method for teaching this skill set. This study investigates the impact and feasibility of teaching a quantitative LVEF assessment method to anesthesiology residents, compared with teaching visual estimation techniques.

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Physicians’ Ability to Visually Estimate Left Ventricular Ejection Fraction, Right Ventricular Enlargement, and Paradoxical Septal Motion After a 2-Day Focused Cardiac Ultrasound Training Course

Cited by 6 publications

References 22 publications

Physicians’ abilities to obtain and interpret focused cardiac ultrasound images from critically ill patients after a 2-day training course

Physicians’ abilities to obtain and interpret focused cardiac ultrasound images from critically ill patients after a 2-day training course

A one‐day focused cardiac ultrasound training has a limited impact on residents’ abilities to visually assess right ventricular dimensions and function

Quantitative Echocardiography Improves Resident Assessment of Left Ventricular Systolic Function

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