Assessment of left ventricular function by intensivists using hand-held echocardiography.
BACKGROUND
Bedside transthoracic echocardiography (TTE) provides rapid and noninvasive hemodynamic assessment of critically ill patients but is limited by the immediate availability of experienced sonographers and cardiologists.


METHODS
Forty-four patients in the medical ICU underwent near-simultaneous limited TTE performed by intensivists with minimal training in echocardiography, and a formal TTE that was performed by certified sonographers and was interpreted by experienced echocardiographers. Intensivists, blinded to the patient's diagnosis and the results of the formal TTE, were asked to determine whether left ventricular (LV) function was grossly normal or abnormal and to place LV function into one of the following three categories: 1, normal; 2, mildly to moderately decreased; and 3, severely decreased.


RESULTS
Using the formal TTE as the "gold standard," intensivists correctly identified normal LV function in 22 of 24 cases (92%) and abnormal LV function in 16 of 20 cases (80%). The kappa statistic for the agreement between intensivist and echocardiographer for any abnormality in LV function was 0.72 (95% confidence interval [CI], 0.52 to 0.93; p < 0.001). Intensivists correctly placed LV function into one of three categories in 36 of 44 cases (82%); in 6 of the 8 cases that were misclassified, the error involved an overestimation of LV function. The kappa statistic for agreement between the intensivist and echocardiographer with regard to placement into one of three categories of LV function was 0.68 (95% CI, 0.48 to 0.88; p < 0.001).


CONCLUSIONS
Intensivists were able to estimate LV function with reasonable accuracy using a hand-held unit in the ICU, despite having undergone minimal training in image acquisition and interpretation.
Melamed
Roman
R
Division of Pulmonary-Critical Care, Hennepin County Medical Center, Minneapolis, MN.
Sprenkle
Mark D
MD
Division of Pulmonary-Critical Care, Hennepin County Medical Center, Minneapolis, MN.
Ulstad
Valerie K
VK
Cardiology, Hennepin County Medical Center, Minneapolis, MN.
Herzog
Charles A
CA
Cardiology, Hennepin County Medical Center, Minneapolis, MN.
Leatherman
James W
JW
Division of Pulmonary-Critical Care, Hennepin County Medical Center, Minneapolis, MN. Electronic address: leath001@umn.edu.
D000328:Adult; D000368:Aged; D002309:Cardiology / Q000592:standards; D002983:Clinical Competence; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D004635:Emergency Medicine / Q000592:standards; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011336:Probability; D011446:Prospective Studies; D011786:Quality Control; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000000981:diagnostic imaging*