Key result
Obstetrician-performed focused cardiac ultrasound yields ~78% agreement with standard echo for cardiac abnormalities.
Why the study?
Cardiac complications are a leading cause of maternal death, but echocardiography is unavailable in many low-resource settings.
Does focused cardiac ultrasound performed by trained obstetricians and interpreted remotely accurately identify cardiac abnormalities in pregnant women in low-resource settings?
Cross-Sectional (n=301)
Yes
Does focused cardiac ultrasound performed by trained obstetricians and interpreted remotely accurately identify cardiac abnormalities in pregnant women in low-resource settings?
Focused cardiac ultrasound performed by trained obstetricians with remote expert interpretation is a feasible and accurate method for screening maternal cardiac disease in low-resource settings.
BACKGROUND: Cardiac complications are a leading cause of maternal death. Cardiac imaging with echocardiography is important for prompt diagnosis, but it is not available in many low-resource settings. The aim of this study was to determine whether focused cardiac ultrasound performed by trained obstetricians and interpreted remotely by experts can identify cardiac abnormalities in pregnant women in low-resource settings. METHODS: A cross-sectional study was conducted among 301 pregnant and postpartum women recruited from 10 hospitals across three states in India. Twenty-two obstetricians were trained in image acquisition using a portable cardiac ultrasound device following a simplified protocol adapted from focus-assessed transthoracic echocardiography protocol. It included parasternal long-axis, parasternal short-axis, and apical four-chamber views on two-dimensional and color Doppler. Independent image interpretation was performed remotely by two experts, in the United Kingdom and India, using a standard semiquantitative assessment protocol. Interrater agreement between the experts was examined using Cohen's κ. Diagnostic accuracy of the method was examined in a subsample for whom both focused and conventional scans were available. RESULTS: Cardiac abnormalities identified using the focused method included valvular abnormalities (27%), rheumatic heart disease (6.6%), derangements in left ventricular size (4.7%) and function (22%), atrial dilatation (19.5%), and pericardial effusion (30%). There was substantial agreement on the cardiac parameters between the two experts, ranging from 93.6% (κ = 0.84) for left ventricular ejection fraction to 100% (κ = 1) for valvular disease. Image quality was graded as good in 79% of parasternal long-axis, 77% of parasternal short-axis and 64% of apical four-chamber views. The chance-corrected κ coefficients indicated fair to moderate agreement (κ = 0.28-0.51) for the image quality parameters. There was good agreement on diagnosis between the focused method and standard echocardiography (78% agreement), compared in 36 participants. CONCLUSIONS: The focused method accurately identified cardiac abnormalities in pregnant women and could be used for screening cardiac problems in obstetric settings.
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Alsharqi et al. (2022) conducted a cross-sectional in Cardiac abnormalities in pregnancy (n=301). Focused cardiac ultrasound by trained obstetricians with remote expert interpretation vs. Standard echocardiography was evaluated on Agreement on diagnosis between focused method and standard echocardiography. Focused cardiac ultrasound performed by trained obstetricians and interpreted remotely showed 78% diagnostic agreement with standard echocardiography for identifying cardiac abnormalities.
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