1
|
Lebeau R, Robert-Halabi M, Pichette M, Vinet A, Sauvé C, Dilorenzo M, Le V, Piette E, Brunet M, Bédard W, Serri K, Poulin F. Left ventricular ejection fraction using a simplified wall motion score based on mid-parasternal short axis and apical four-chamber views for non-cardiologists. BMC Cardiovasc Disord 2023; 23:115. [PMID: 36890433 PMCID: PMC9993504 DOI: 10.1186/s12872-023-03141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND There is a need for a convenient, yet reliable method to assess left ventricular ejection fraction (LVEF) with point-of-care ultrasound study (POCUS). We aim to validate a novel and simplified wall motion score LVEF based on the analysis of a simplified combination of echocardiographic views. METHODS In this retrospective study, transthoracic echocardiograms of randomly selected patients were analysed by the standard 16-segments wall motion score index (WMSI) to derive the reference semi-quantitative LVEF. To develop our semi-quantitative simplified-views method, a limited combination of imaging views and only 4 segments per view were tested: (1) A combination of the three parasternal short-axis views (PSAX BASE, MID-, APEX); (2) A combination of the three apical views (apical 2-chamber, 3-chamber and 4-chamber) and (3) A more limited combination of PSAX-MID and apical 4-chamber is called the MID-4CH. Global LVEF is obtained by averaging segmental EF based on contractility (normal = 60%, hypokinesia = 40%, and akinesia = 10%). Accuracy of the novel semi-quantitative simplified-views WMS method compared to the reference WMSI was evaluated using Bland-Altman analysis and correlation was assessed in both emergency physicians and cardiologists. RESULTS In the 46 patients using the 16 segments WMSI method, the mean LVEF was 34 ± 10%. Among the three combinations of the two or three imaging views analysed, the MID-4CH had the best correlation with the reference method (r2 = 0.90) with very good agreement (mean LVEF bias = - 0.2%) and precision (± 3.3%). CONCLUSIONS Cardiac POCUS by emergency physicians and other non-cardiologists is a decisive therapeutic and prognostic tool. A simplified semi-quantitative WMS method to assess LVEF using the easiest technically achievable combination of mid-parasternal and apical four-chamber views provides a good approximative estimate for both non-cardiologist emergency physicians and cardiologists.
Collapse
Affiliation(s)
- Réal Lebeau
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Maxime Robert-Halabi
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Maxime Pichette
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Alain Vinet
- Centre de Rercherche de l'Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Claude Sauvé
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Maria Dilorenzo
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Viet Le
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Eric Piette
- Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Mathieu Brunet
- Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - William Bédard
- Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Karim Serri
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada
| | - Frédéric Poulin
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Blvd W., Montreal, QC, H4J 1C5, Canada.
| |
Collapse
|
2
|
Lebeau R, Serri K, Lorenzo MD, Sauvé C, Le VHV, Soulières V, El-Rayes M, Pagé M, Zaïani C, Garot J, Poulin F. Assessment of LVEF using a new 16-segment wall motion score in echocardiography. Echo Res Pract 2018; 5:63-69. [PMID: 29628446 PMCID: PMC5887066 DOI: 10.1530/erp-18-0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/21/2018] [Indexed: 11/08/2022] Open
Abstract
Background Simpson biplane method and 3D by transthoracic echocardiography (TTE), radionuclide angiography (RNA) and cardiac magnetic resonance imaging (CMR) are the most accepted techniques for left ventricular ejection fraction (LVEF) assessment. Wall motion score index (WMSI) by TTE is an accepted complement. However, the conversion from WMSI to LVEF is obtained through a regression equation, which may limit its use. In this retrospective study, we aimed to validate a new method to derive LVEF from the wall motion score in 95 patients. Methods The new score consisted of attributing a segmental EF to each LV segment based on the wall motion score and averaging all 16 segmental EF into a global LVEF. This segmental EF score was calculated on TTE in 95 patients, and RNA was used as the reference LVEF method. LVEF using the new segmental EF 15-40-65 score on TTE was compared to the reference methods using linear regression and Bland–Altman analyses. Results The median LVEF was 45% (interquartile range 32–53%; range from 15 to 65%). Our new segmental EF 15-40-65 score derived on TTE correlated strongly with RNA-LVEF (r = 0.97). Overall, the new score resulted in good agreement of LVEF compared to RNA (mean bias 0.61%). The standard deviations (s.d.s) of the distributions of inter-method difference for the comparison of the new score with RNA were 6.2%, indicating good precision. Conclusion LVEF assessment using segmental EF derived from the wall motion score applied to each of the 16 LV segments has excellent correlation and agreement with a reference method.
Collapse
Affiliation(s)
- Real Lebeau
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Karim Serri
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Maria Di Lorenzo
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Claude Sauvé
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Van Hoai Viet Le
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Vicky Soulières
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Malak El-Rayes
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Maude Pagé
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Chimène Zaïani
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Jérôme Garot
- Institut cardiovasculaire Paris Sud, Massy, France
| | - Frédéric Poulin
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| |
Collapse
|
3
|
Senthilnathan M, Kundra P, Mishra SK, Velayudhan S, Pillai AA. Competence of Intensivists in Focused Transthoracic Echocardiography in Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2018; 22:340-345. [PMID: 29910544 PMCID: PMC5971643 DOI: 10.4103/ijccm.ijccm_401_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: Focused transthoracic echocardiography (fTTE) in critical care can be used to assess patient's volume status, ventricular contractility, right ventricle chamber size, and valvular abnormalities. The objective of the study was to assess the competency of intensivists in performing fTTE in Intensive Care Unit (ICU) patients after a brief training course by cardiologist using a specific ECHO protocol. Methods: One hundred and four patients in ICU were recruited for this prospective observational study over a period of 12 months. Intensivists were trained for 60 h (2 h/day for 30 days). Intensivists performed fTTE in 82 ICU patients using a specific ECHO protocol developed in consensus with cardiologists. Each patient was assessed by an intensivist and two blinded cardiologists. At the end of the study period, the competency of intensivists was compared with two cardiologists and analyzed using intraclass correlation coefficient (ICC). Results: There were excellent agreement between intensivists and cardiologists in terms of measuring ejection fraction (ICC estimate was 0.973–0.987), valvular function (ICC estimate for mitral valve was 0.940–0.972; ICC estimate for aortic valve was 0.872–0.940), and ICC estimate for pulmonary hypertension was 0.929–0.967. Good reliability has been found for the assessment of volume status with inferior vena cava diameter (ICC estimate for assessing hypovolemia was 0.790–0.902). Conclusion: Intensivists with requisite training in TTE were able to perform focused echocardiography with comparable accuracy to that of cardiologists. Further studies are required to elucidate the therapeutic implications of fTTE performed by the intensivists.
Collapse
Affiliation(s)
- Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandeep Kumar Mishra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Savitri Velayudhan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
4
|
Lebeau R, Sas G, El Rayes M, Serban A, Moustafa S, Essadiqi B, DiLorenzo M, Souliere V, Beaulieu Y, Sauve C, Amyot R, Serri K. Left ventricular ejection fraction assessment by non-cardiologists from transverse views using a simplified wall motion score index. Echo Res Pract 2015; 2:1-8. [PMID: 26693310 PMCID: PMC4676426 DOI: 10.1530/erp-14-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/06/2015] [Indexed: 11/08/2022] Open
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.
Collapse
Affiliation(s)
- Real Lebeau
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Georgetta Sas
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Malak El Rayes
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Alexandrina Serban
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Sherif Moustafa
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Btissama Essadiqi
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Maria DiLorenzo
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Vicky Souliere
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Yanick Beaulieu
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Claude Sauve
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Robert Amyot
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Karim Serri
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| |
Collapse
|
5
|
Lebeau R, Serri K, Morice MC, Hovasse T, Unterseeh T, Piéchaud JF, Garot J. Assessment of left ventricular ejection fraction using the wall motion score index in cardiac magnetic resonance imaging. Arch Cardiovasc Dis 2012; 105:91-8. [PMID: 22424327 DOI: 10.1016/j.acvd.2012.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/29/2011] [Accepted: 01/06/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) is an important indicator of left ventricular function and of the severity and prognosis of ischaemic heart disease. Assessment of regional function using the wall motion score index (WMSI) is an alternative means of evaluating left ventricular function. AIM We attempted to evaluate LVEF by a method using the WMSI with cardiac magnetic resonance imaging (MRI). METHODS One hundred and twenty-two patients referred for evaluation of heart disease had rest WMSI evaluation by cardiac MRI. The WMSI was evaluated using the 16-segment model and score proposed by the American Society of Echocardiography. In our first group of 80 patients, a correlation between WMSI and cardiac MRI LVEF was established and a regression equation was derived. This regression equation was then used in 42 consecutive patients to compare WMSI LVEF with the gold standard MRI LVEF. RESULTS In the first 80 patients, MRI LVEF and WMSI correlated very well (r=0.93). Similarly, in the second group of 42 patients, WMSI LVEF derived from the regression equation correlated very well with MRI LVEF (r=0.94). CONCLUSION An objective evaluation of LVEF can be easily made using the WMSI with cardiac MRI, which correlates very well with standard MRI planimetric methods.
Collapse
Affiliation(s)
- Réal Lebeau
- Hôpital du Sacré-Coeur de Montréal, université de Montréal, Canada.
| | | | | | | | | | | | | |
Collapse
|