Volume 6 Supplement 1
Reproducibility of point-of-care cardiac ultrasound in Chagas disease by a non-cardiologist with limited training
© Kreuser et al; licensee Springer. 2014
Published: 31 January 2014
Chagas disease is a major cause of heart failure in Latin America. Many Chagas disease patients live in rural areas under poor economic conditions with limited access to formal echocardiography. Point-of-care ultrasound is rapidly gaining recognition as a powerful diagnostic tool in such fields as emergency medicine, intensive care, and primary care, but is not commonly utilized in Chagas-endemic regions. In this study we sought to determine the reproducibility of point-of-care cardiac ultrasound performed by a non-cardiologist in Chagas patients.
Consecutive patients with Chagas disease receiving regularly-scheduled echocardiograms were recruited at a tertiary care teaching hospital in Brazil. A board-certified cardiologist performed and interpreted an echocardiogram with a conventional full function echocardiography machine (iE33 Philips Medical Systems), and a 4th-year medical student performed and interpreted a cardiac exam with a portable ultrasound machine (Sonosite MicroMaxx). The medical student was blind to clinical and the cardiologist’s echocardiographic data. A range of quantitative and visual estimation data were collected and compared between the two exams.
A total of 41 patients (mean age=49.5) were examined, and 16 (39%) had at least mild LV systolic dysfunction per the cardiologist´s exam. Measurements from the two observers were highly correlated (ICC values for Long-axis LVDd=0.958 and LVEF=0.930). Qualitative visual estimation of LV systolic function was highly reproducible (Kappa = 0.76, Observed agreement = 0.854), as was RV systolic function (Kappa = 0.55, Observed agreement 0.900).
Point-of-care cardiac ultrasound performed and interpreted by a non-cardiologist with limited ultrasound training is accurate and reproducible for detecting cardiac dysfunction. Point-of-care cardiac ultrasound provides clinically valuable information in patients with Chagas disease and could help clinicians determine management of such patients in a wide variety of care settings.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.