Cardiology ; education ; standards ; Echocardiography ; Humans ; Inservice Training

Objectives To learn the echocardiography skills of intensivists after receiving a basic critical care echocardiography training course, and investigate factors that may influence their performance. Methods We completed a web-based questionnaire that assessed the skills in ultrasound scanning techniques of intensivists who took a training course on basic critical care echocardiography held in 2019 and 2020. Mann-Whitney test was used to analyze the factors which might affect their performance on image acquisition, recognizing clinical syndrome, and measuring the diameter of inferior vena cava, left ventricular ejection fraction and left ventricular outflow tract velocity-time integral.Results We enrolled 554 physicians from 412 intensive care units across China. Among them, 185 (33.4%) reported that they had 10%-30% chance of being misled by critical care echocardiography when making therapeutic decision, and 34 (6.1%) reported that the chance was greater than 30%. Intensivists who performed echocardiography under the guidance of a mentor and finished ultrasound scanning more than 10 times per week reported significant higher scores in image acquisition, clinical syndrome recognition, and quantitative measurement of inferior vena cava diameter, left ventricular ejection fraction and left ventricular outflow tract velocity-time integral than those without mentor and performing echocardiography 10 times or less per week respectively (all P < 0.05).Conclusion The skills in diagnostic medical echocardiography of Chinese intensivists after a basic echocardiographic training course remain low, and further quality assurance training program is clearly warranted.
Humans ; Clinical Competence ; East Asian People ; Echocardiography/standards* ; Stroke Volume ; Ventricular Function, Left ; Self-Assessment ; Physicians/standards* ; Internal Medicine/standards*

INTRODUCTIONDigital storage of echocardiographic data offers logistical advantages over videotape archival. However, limited information is available on the accuracy of clinically compressed digitised examinations, an important consideration for patient safety.

MATERIALS AND METHODSTransthoracic echocardiograms of 520 consecutive patients were prospectively acquired digitally and on videotape. Two echocardiologists, in consensus, reported studies in both formats sequentially. Using the videotape as a reference, the significance of any reported differences was graded from both imaging and clinical standpoints, and the reasons for these differences identified.

RESULTSFrom an imaging perspective, differences between digital and videotaped studies were absent or minor in 459 cases (88%), fairly significant in 55 (11%) and very significant in 6 (1%). The main reasons for the observed differences were inadequate acquisition of optimal views (59%), an insufficient number of acquired cardiac cycles (25%) and suboptimal image quality (9%). These differences were considered to be of possible or definite clinical importance in 21 (4%) and 8 (2%) cases, respectively. In multinominal logistic regression models, the only independent predictor of significant difference between digitised and videotaped images was study complexity. Regardless of case complexity, most diagnostic errors arising from digital review were attributable to technical failure rather than observer error.

CONCLUSIONSThe potential for important errors arising from exclusive reporting of clinically compressed digital echocardiograms is small. Digital echocardiography, as practiced in a routine clinical setting, offers a patient-safe alternative to videotape review.

Echocardiography ; methods ; standards ; Humans ; Image Processing, Computer-Assisted ; Prospective Studies ; Safety ; Singapore ; Videotape Recording

Echocardiography, Transesophageal ; Humans ; Monitoring, Physiologic ; standards ; Pulmonary Circulation ; physiology ; Pulmonary Wedge Pressure ; Stroke Volume

OBJECTIVETo compare the value of the new national criteria (2 major or one major plus 3 minor criteria) with the Duke criteria for diagnosis of infective endocarditis (IE).

METHODSA total of 205 patients with clinical diagnosis of IE admitted at West China Hospital of Sichuan University were included in this study. Among them, IE was pathologically confirmed in 97 patients. The sensitivities of both criteria for the diagnosis of IE were compared.

RESULTSIn 205 cases, the same microorganisms were detected twice in blood cultures in 13 cases (8.3%). Vegetations were detected by echocardiography in 183 patients (89.3%). In 97 cases with pathologically confirmed IE, the same microorganisms were detected twice in blood cultures in 6 cases (6.2%). Vegetations were detected by echocardiography in 89 patients (91.8%). IE diagnose was made in 44 (45.5%) and 86 (88.7%, P < 0.05 vs. Duke criteria) out of 97 pathologically confirmed IE patients by the Duke criteria and new national criteria, respectively. The specificities were 100% and 95.7% by Duke and new national criteria, respectively (P > 0.05).

CONCLUSIONWith the addition of echocardiographic evidence of endocardial involvement and 2 minor criteria as definite diagnostic criteria, the sensitivity of the new national criteria is superior to that of the Duke criteria for diagnosing IE and the specificity for the diagnosis of IE between the two criteria is similar.

Adolescent ; Adult ; Aged ; Child ; Echocardiography ; standards ; Endocarditis, Bacterial ; diagnosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Reference Standards ; Sensitivity and Specificity ; Young Adult

Bacteremia ; diagnosis ; microbiology ; Bacteria ; isolation & purification ; Child ; Echocardiography ; Echocardiography, Transesophageal ; Endocarditis, Bacterial ; diagnosis ; diagnostic imaging ; microbiology ; pathology ; Humans ; Reference Standards ; Sensitivity and Specificity

This study was conducted to evaluate the usefulness of coronary arterial profiles from normal dogs (11 animals) and canines (six dogs) with experimental myocardial infarction (MI) induced by ligation of the left coronary artery (LCA). Blood velocity of the LCA and right coronary artery (RCA) were evaluated following transthoracic pulsed-wave Doppler echocardiography. The LCA was observed as an infundibular shape, located adjacent to the sinus of Valsalva. The RCA appeared as a tubular structure located 12 o'clock relative to the aorta. In normal dogs, the LCA and RCA mean peak diastolic velocities were 20.84 +/- 3.24 and 19.47 +/- 2.67 cm/sec, respectively. The LCA and RCA mean diastolic deceleration times were 0.91 +/- 0.14 sec and 1.13 +/- 0.20 sec, respectively. In dogs with MI, the LCA had significantly (p < 0.01) lower peak velocities (14.82 +/- 1.61 cm/sec) than the RCA (31.61 +/- 2.34 cm/sec). The RCA had a significantly (p < 0.01) rapid diastolic deceleration time (0.71 +/- 0.06 sec) than that found in the LCA (1.02 +/- 0.22 sec) of MI dogs. In conclusion, these profiles may serve as a differential factor for evaluating cardiomyopathy in dogs.
Animals ; Blood Flow Velocity/*veterinary ; Coronary Vessels/surgery/*ultrasonography ; Dog Diseases/*diagnosis ; Dogs/*physiology ; Echocardiography, Doppler, Pulsed/standards/*veterinary ; Female ; Male ; Myocardial Infarction/diagnosis/*veterinary

OBJECTIVEEighteen to twenty-four percent of patients with infective endocarditis (IE) proved pathologically were clinically possible IE by the Duke criteria. In order to improve the sensitivity, the new criteria (trial) for the diagnosis of IE was proposed by Pediatric Cardiology Association of China and Editorial Committee of Chinese Journal of Pediatrics. The aim of this study was to evaluate and compare the value of the new criteria (trial) for the diagnosis of IE with the Duke criteria.

METHODSGroup A consisted of 193 patients proved with IE at autopsy or surgery, where the cases had the results of blood culture and echocardiography data, and Group B had 23 patients with clinical diagnosis of IE in whom evidence of IE was not found at surgery. All the above cases were collected from 15 hospitals. They were analyzed and classified by the new criteria and at the same time by the Duke criteria. The sensitivity and specificity of both criteria for the diagnosis of IE were compared.

RESULTS(1) In Group A, same microorganisms were detected twice in blood culture in 50 patients (25.9%), while 36 patients (18.7%) had only one positive blood culture. Endocardial involvement was found by echocardiography in 165 cases (85.5%), including vegetation in 160 (82.9%), perforation of aortic valve in 4 (2.1%), and partial dehiscence of ventricular septal defect (VSD) patch in one (0.5%). Vegetation appeared oscillating masses in 100 cases (62.5%). One hundred and eighty (93.3%) patients had predisposing heart conditions, and 151 (72.8%) with congenital heart diseases. Fever was revealed in 178 cases (92.2%). Vegetation or perforation of aortic valve was detected in all patients without fever. Heart failure was complicated in 91 patients, 7 of whom had no fever. Vascular phenomena including petechiae and major arterial emboli occurred in 21 and 28 cases, respectively. Among immunologic phenomena, glomerulonephritis occurred in 9, elevated rheumatoid factor in 17/25 and elevated CRP in 51/71. In Group B, the same microorganism was detected in blood culture twice in only 3 patients and 2 patients had one positive blood culture. Vegetation in tricuspid valve was found by echocardiography in one patient. (2) Ninety-four cases (48.7%) of Group A were clinically confirmed IE by the Duke criteria. The diagnosis was made on the basis of two major criteria in 42, one major and 3 minor criteria in 52.14 of 99 as possible IE were excluded by the modified Duke criteria. On the other hand, a definite diagnosis of IE was made in 156 patients (80.8%) by the new criteria. Of them, 94 met with definite criteria of the Duke criteria, 62 (32%) met with echocardiographic evidence of endocardial involvement (major criteria) and two minor criteria. No patient of Group B was clinically definite with the Duke criteria, but one patient was clinically definite with the new criteria (trial). (3) The sensitivity and specificity for the diagnosis of IE were 80.8% and 95.7%, respectively, with the new criteria (trial), 48.7% and 100%, respectively, with the Duke criteria.

CONCLUSIONWith the addition of echocardiographic evidence of endocardial involvement (major criteria) and 2 minor criteria as definite diagnostic criteria, the sensitivity of the new criteria (trial) is superior to that of the Duke criteria, but there is no significant difference in specificity for the diagnosis of IE between the two criteria.

Adolescent ; Adult ; Autopsy ; Bacteria ; isolation & purification ; Child ; Child, Preschool ; Echocardiography ; Endocarditis, Bacterial ; diagnosis ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Practice Guidelines as Topic ; standards ; Risk Factors

To evaluate the feasibility and usefulness of transthoracic Doppler echocardiography (TTDE) as a non-invasive method in recording distal anterior descending (LAD) coronary flow velocity, we compared coronary flow reserve (CFR) measured by TTDE with measurements by intracoronary Doppler wire (ICDW). Twenty-one patients without LAD stenosis were studied. ICDW performed at baseline and after intracoronary injection of 18 microg adenosine. TTDE was performed at baseline and after intravenous adenosine (140 microg/kgmin for 2 min). Adequate Doppler recordings of coronary flow velocities during systole were obtained in 14 of 21 study patients (67%) and during diastole in 17 (81%) patients. Baseline and hyperemic peak diastolic flow velocities measured by TTDE were significantly smaller than those obtained by ICDW (p<0.05). However, diminishing trends of diastolic and systolic velocity ratio after hyperemia were similarly observed in both methods. CFR obtained by TTDE (3.0+/-0.5), was higher than the value calculated by ICDW (2.5+/-0.4). There were significant correlations between the values obtained by the two methods (r=0.72, p<0.01). It is concluded that TTDE is a feasible method in measuring coronary flow velocity and appears to be a promising non-invasive method in evaluating CFR.
Adult ; Aged ; Blood Flow Velocity ; Comparative Study ; Coronary Angiography ; Coronary Circulation* ; Coronary Disease/ultrasonography* ; Echocardiography, Doppler/standards ; Echocardiography, Doppler/methods* ; Female ; Heart Rate ; Human ; Hyperemia/ultrasonography ; Linear Models ; Male ; Middle Age ; Prospective Studies ; Reproducibility of Results

To determine normal values for Doppler parameters of left ventricular function, ascending aortic blood flow velocity was measured by pulsed wave Doppler echocardiography in 63 healthy children with body surface area (BSA) <1 m(2) (age <10 yr). Peak velocity was independent of sex, but increased with body size. Mean acceleration was related to peak velocity (r=0.75, p<0.0001). Both stroke distance and ejection time had strong negative correlations with heart rate and positive correlations with BSA, suggesting that these parameters should be evaluated in relation to heart rate and body size. Mean intra- and interobserver variability for peak velocity, ejection time, stroke and minute distance ranged from 3 to 7%, whereas variability for acceleration time was 9 to 13%. These data may be used as reference values for the assessment of hemodynamic states in young children with cardiac disease.
Age Factors ; Aorta/*physiology ; Blood Flow Velocity ; Body Constitution ; Child ; Child, Preschool ; Echocardiography, Doppler/*standards/statistics & numerical data ; Female ; Heart Rate ; Human ; Infant ; Infant, Newborn ; Male ; Observer Variation ; Reference Values ; Stroke Volume