Echocardiographic screening of pregnant women by non-physicians with remote interpretation in primary care
Echocardiographic screening of pregnant women by non-physicians with remote interpretation in primary care
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DOI：
10.1093/fampra/cmaa115
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发表时间：
2021-06-01
期刊：
影响因子：
2.2
通讯作者：
Beaton, Andrea Z.
中科院分区：
文献类型：
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作者：
Nascimento, Bruno R.;Sable, Craig;Beaton, Andrea Z.
背景资料：心脏病（HD）对pregnancy is significant.Objective：我们的目的是评估整合筛选超声心动图（回声）到巴西产前初级保健的可行性，以评估HD prevalence.Methods：超过13个月，20名医护人员获得简化的回声协议，利用手持机器（GE-VSCAN），在22个初级保健中心。在美国和巴西，不知道HD的妊娠妇女接受了聚焦超声心动图，并进行了远程解读。严重HD定义为结构性瓣膜异常、轻度以上瓣膜功能障碍、心室收缩功能障碍/肥大或其他严重异常。筛查阳性的妇女被称为标准echo.Results：在总的，1 112名妇女进行了筛选。平均年龄为27 ± 8岁，平均胎龄为22 ± 9周。在100例（9.0%）患者中发现了严重HD。轻度以上二尖瓣返流47例（4.2%），三尖瓣返流11例（1.0%），轻度左心室功能不全4例（0.4%），左心室肥厚2例（0.2%），疑似风湿性心脏病36例（3.2%）：所有患者均累及二尖瓣，2例累及主动脉瓣（AV）。11例（10%）观察到其他AV疾病。在56名接受标准超声心动图检查的筛查阳性女性中，45名确诊为主要HD（80.4%）：12例患者的RHD结果（所有患者均患有二尖瓣，2例患有AV疾病），40例二尖瓣返流（14例形态学改变，10例提示风湿性心脏病），2例其他AV疾病结论：在巴西，将超声心动图筛查纳入初级产前保健是可行的。然而，严重疾病的低发病率促使进一步调查该战略的有效性。
Background: Impact of heart disease (HD) on pregnancy is significant.Objective: We aimed to evaluate the feasibility of integrating screening echocardiography (echo) into the Brazilian prenatal primary care to assess HD prevalence.Methods: Over 13 months, 20 healthcare workers acquired simplified echo protocols, utilizing hand-held machines (GE-VSCAN), in 22 primary care centres. Consecutive pregnant women unaware of HD underwent focused echo, remotely interpreted in USA and Brazil. Major HD was defined as structural valve abnormalities, more than mild valve dysfunction, ventricular systolic dysfunction/hypertrophy, or other major abnormalities. Screen-positive women were referred for standard echo.Results: At total, 1 112 women underwent screening. Mean age was 27 +/- 8 years, mean gestational age 22 +/- 9 weeks. Major HD was found in 100 (9.0%) patients. More than mild mitral regurgitation was observed in 47 (4.2%), tricuspid regurgitation in 11 (1.0%), mild left ventricular dysfunction in 4 (0.4%), left ventricular hypertrophy in 2 (0.2%) and suspected rheumatic heart disease in 36 (3.2%): all, with mitral valve and two with aortic valve (AV) involvement. Other AV disease was observed in 11 (10%). In 56 screen-positive women undergoing standard echo, major HD was confirmed in 45 (80.4%): RHD findings in 12 patients (all with mitral valve and two with AV disease), mitral regurgitation in 40 (14 with morphological changes, 10 suggestive of rheumatic heart disease), other AV disease in two (mild/moderate regurgitation).Conclusions: Integration of echo screening into primary prenatal care is feasible in Brazil. However, the low prevalence of severe disease urges further investigations about the effectiveness of the strategy.