Non-Specialised Medical Staff Assessing Left Ventricular Systolic Function by Measuring Mitral Annular Excursion via Hand-Held Echocardiography Device and Automated Atrioventricular-Plane Tracking Algorithm

Abstract

Increased portability and automation of echocardiography provides potential for point-of-care, focussed assessments. Screening for left ventricular systolic dysfunction via non-specialised staff is now a real possibility. Determine accuracy and feasibility of first-in-man technology, mitral annular excursion (MAE) via hand-carried ultrasound (HCU; integrated with an automatic atrio-ventricular plane algorithm ‘AutoMAE’) performed by non-specialised medical staff. Three junior doctors (no prior experience in echocardiography) completed brief didactic lectures followed by practical training in 10 practice patients. A cardiac sonographer and the three doctors then performed HCU AutoMAE (AV plane App on Vscan ExtendTM; apical four chamber orientation) on consecutive patients with echocardiography performed clinically <24hrs; all with feasible image quality and in sinus rhythm. AutoMAE measures (junior doctors and sonographer) were compared to standard echocardiographic Biplane LVEF (BPLVEF) using receiver-operator characteristic (binary classification 50% BPLVEF; criterion cut-off 9mm MAE); mean difference with bias analyses were also performed. Collective junior doctor performed cohort was n=44 (58±14yrs; 64% male; BPLVEF 55±12%), with doctor-specific subcohorts (#1-#3) demonstrating good feasibility 82-86%. Sonographer cohort (n=36; 59±14yrs; 64% male; biplane LVEF 55±11%) demonstrated 94% feasibility. Doctor subcohorts AutoMAE measures (pairwise) found mean difference /bias (mm) at 1.6/-0.1, 1.0/-0.3 and 1.7/+0.1 (respectively) when compared to sonographer AutoMAE. Non-specialised junior doctors performing HCU AutoMAE assessment after brief training is accurate and feasible. This could permit monitoring for left ventricular systolic dysfunction in high-risk patient cohorts.Tabled 1CohortCollective DrSonographerDr #1Dr #2Dr #3Cohort % with BPLVEF ≤50%27%31%23%28%17%Area under Curve0.850.910.840.860.90Sensitivity93%85%97%93%100%Specificity64%84%63%64%74% Open table in a new tab