Ponovljivost in zanesljivost ehokardiografskih meritev za oceno diastolične funkcije : magistrsko delo

Pečnik, Nejka Jerneja (author), Mekiš, Nejc (mentor), Tretjak, Martin (comentor), Fošnarič, Miha (reviewer)

Uvod: Ultrazvočna preiskava srca je nepogrešljiva preiskovalna metoda, s katero lahko predvidimo potek zdravljenja preiskovanca. Med drugim ima ehokardiografija osrednjo vlogo pri oceni diastolične funkcije. Z izrazom diastolična disfunkcija označujemo več motenj v delovanju levega prekata, zaradi katerih se levi prekat v diastoli ne more primerno polniti brez povišanega polnilnega tlaka. Namen: Z nalogo smo preverjali ponovljivost in zanesljivost meritev diastolične funkcije srca med radiološkim inženirjem in specialistom kardiologom. Raziskovali smo tudi upoštevanje takrat posodobljenih priporočil za ocenjevanje diastolične funkcije. Metode dela: V raziskavi smo primerjali prisotnost in meritve diastolične funkcije z meritvami, ki so bile narejene pri pacientih leta 2019 v Slovenj Gradcu. Po pregledu literature smo na digitalno arhiviranih posnetkih predhodno narejenih ehokardiografskih preiskav odčitali meritve (E, A, e’sept, e’ lat, TR ^^^^, LAVI) pri sto zaporedno opravljenih preiskavah, ki so bile opravljene po letu 2019. Izključili smo bolnike z atrijsko fibrilacijo in prirojenimi srčnimi anomalijami. Meritve so bile izvedene s pomočjo doplerske ehokardiografije (pulzni, kontinuirani in tkivni dopler). Prisotnost diastolične disfunkcije smo ocenili s pomočjo priporočil in jo primerjali z oceno, ki je bila zapisana v izvidu pacienta. Po izračunani statistiki povprečji, smo opravili Bland-Altmanovo analizo za primerljivost meritev, intraklasni korelacijski koeficient za oceno zanesljivosti in Kappa statistiko za ujemanje končnega izvida pacientov. Rezultati: Z analizo povprečji smo ugotovili, da obstajajo statistično značilne razlike pri meritvah e'sept (p=0,005, razlika med povprečjema je 2,8%) in e'lat (p=0,31, razlika med povprečjema je 4,2%). Za vse parametre smo izrisali Bland-Altmanove diagrame razlik, prikazali smo dobro ujemanje pri vseh parametrih z normalno porazdelitvijo. Pri e'sept in e'lat so razlike med ocenjevalcema signifikantne, vendar znotraj zadanih praktičnih mej sprejemljivosti. Z intraklasnim korelacijskim koeficientom smo dokazali visoko zanesljivost pri vseh parametrih. Skoraj popolno ujemanje prisotnosti diastolične funkcije smo dokazali s Kappa koeficientom (?=0,810). Med sto opravljenimi preiskavami so največkrat bile izpuščene naslednje meritve: TR ^^^^ (35-krat; deloma predpisujemo fizični odsotnosti regurgitacije), e'lat (25- krat), LAVI (23-krat), e'sept (9-krat). Razprava in zaključek: Z nalogo smo dokazali visoko ponovljivost in zanesljivost meritev pomembnih za oceno diastolične funkcije med radiološkim inženirjem in specialistom kardiologom. Med sto pacienti do različne ocene diastolične funkcije ni prišlo zaradi razlike med meritvami, zato sklepamo, da razlike med ocenjevalcema niso klinično pomembne.

• Language: Slovenian
• Keywords: magistrska dela, radiološka tehnologija, ultrazvok srca, ehokardiografija, diastolična funkcija, diastolična disfunkcija, ponovljivost meritev, zanesljivost, radiološki inženirji
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [N. J. Pečnik]
• Year: 2024
• Number of pages: 54 str., [4] str. pril.
• PID: 20.500.12556/RUL-155330
• UDC: 616-07
• COBISS.SI-ID: 190497539
• Publication date in RUL: 27.03.2024

PEČNIK, Nejka Jerneja, 2024, Ponovljivost in zanesljivost ehokardiografskih meritev za oceno diastolične funkcije : magistrsko delo [online]. Master’s thesis. Ljubljana : N. J. Pečnik. [Accessed 5 April 2025]. Retrieved from: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=eng&id=155330

Secondary language

• Language: English
• Title: Reproducibility and reliability of echocardiographic assessment of diastolic function : master thesis

Abstract

Introduction: Echocardiography is a valuable diagnostic test to evaluate the cardiovascular system and assess physiologic function in a variety of diseases. Diastolic dysfunction is a common condition and a valuable factor for predicting hospitalization and mortality; therefore, assessment of diastolic function should be a part of every routine echocardiogram. Purpose: Interested in reproductivity of diastolic measurements, between cardiologist and radiographer, we have revaluated one hundred echocardiographic examinations made in 2019. Also assessing the usage of new Recommendations for Echocardiographic Assessment of Left Ventricular Diastolic Function. Methods: Descriptive method was used to review the internet and library literature. Retrospective analaysis of measurements, using different dopler tehniques (pulsed, continuous wave doppler and tissue doppler), has been carried out among one hundred consecutive cardiac ultrasound examinations, made in echocardiographic laboratory in Slovenj Gradec in 2019; excluding patients with atrial fibrillation and genetic heart diseases. Focusing on measurements that are necessary for diastolic evaluation (E, A, e’sept, e’ lat, TR ^^^^, LAVI).We have used bias assessment to indicate the true difference in two data points, Bland-Altman plot to demonstrate the degree of agreement and Cohen's κ to asses agreement of two observers. We have used plots to present the usage of latest recommendations for grading diastolic function. Results: With bias statistical tests we have determined that there are significant differences in paired data for e'sept, e'lat measurements. With the Bland- Altman we demonstrate degree of agreement between both operators for all parameters. The agreement was excellent for all parameters except for e'sept and e'lat. Nevertheless inter-observer reproducibility of diastolic function was excellent for most diastolic function parameters, with limits of agreement sufficiently narrow to conclude that the fluctuation in measures is unlikely to have noteworthy impact in classification of diastolic function. Kappa statistics demonstrates a strong agreement between the two observers with regard to diastolic dysfunction identification (κ=0,810). Regarding the latest recommendations for diastolic function, left out measurements (TR ^^^^ and others) testify to poor usage of current guidelines. Discussion and conclusion: We provide strong evidence to support that reproducibility of echocardiographic parameters for diastolic function between radiographers and cardiologist is high, and that fluctuation in Measurements in unlikely to have noteworthy impact on diastolic function classification. Also the inter-observer agreement of echocardiographic parameters for diastolic function is excellent, with regard to diastolic dysfunction presence. The assessment of diastolic function should be a part of every routine cardiogram, with adherence to guideline recommendations.

• Keywords: master's theses, radiologic technology, heart ultrasound, echocardiography, diastolic function, diastolic dysfunction, reproductivity, repeatability, radiographers