الفهرس 
Basic echocardiographyOnly 14 pages are availabe for public view
Abstract
This prospective study was conducted on three hundred patients admitted to the RICU at Abbasia Chest Hospital during the period between January 2015 and December 2015. The study included 221 males and 79 females with mean age ± SD 52±17.3 years.
Basic echocardiography was performed to 300 patients (82.9%) admitted to the RICU to assess the impact of integrating basic echocardiography in routine assessment of patients admitted to the RICU and how it would affect the outcome of these patients. Concordance between the investigator’s and the cardiologist’s basic echo findings was evaluated.
from the present study, the following results were obtained:
- The most common pulmonary diseases among the studied group included COPD in 114/300 patients (38%), pneumonia in 74/300 patients (24.7%) and pulmonary tuberculosis in 47/300 patients (15.7%).
- Basic echocardiography findings among the studied cases showed that 91/300 patients (30.3%) had normal echocardiography, while 209/300 patients (69.7%) had cardiac abnormalities.
- Basic echocardiography added unsuspected serious conditions to the diagnosis in 33 (11%) patients; 5 patient with massive pericardial effusion, 22 patients who required inotropics due to dilated cardiomyopathy in 11 patients and ischemic cardiomyopathy in 11 patients, 5 patients with DVT, and one patient with aortic aneurysm. Also confirmed 7 patients with massive pulmonary embolism and 13 patients with DVT.
- Basic echocardiography supported the use of anti-ischemic measures in 8 patients with ischemic cardiomyopathy. Fluid restriction was supported in 6 patients due to ischemic cardiomyopathy, in 2 patients due to dilated cardiomyopathy, in 2 patients duo to mitral stenosis and in one patient due to right sided heart failure. Therapeutic anticoagulant prescription was supported in 16 patient due to lower limb DVT in 9 patients, massive pulmonary embolism in 3 patients, lower limb DVT and massive pulmonary embolism in 4 patients.
- Therapeutic anticoagulants were added to 8 patients (lower limb DVT in 5 patients, right atrial thrombus in 1 patient, left ventricular thrombus in 1 patient, and left atrial spontaneous echo contrast due to severe mitral stenosis in one patient). Inotropics were added in 22 patients (dilated cardiomyopathy in 11 patients and ischemic cardiomyopathy in 11 patients). Diuretics were added to 5 patients with dilated cardiomyopathy, 7 patients with ischemic cardiomyopathy, 10 patients with right sided failure, and 5 patients with mitral stenosis.
- Surgical intervention (valve repair or valve replacement) was recommended in 20 patients with persistent infective endocarditis, and in 4 patients with tight mitral stenosis secondary to rheumatic heart disease. Pericardiocentesis was performed in 2 patients with cardiac tamponade. Thrombolysis with streptokinase was prescribed in 7 patients with massive pulmonary embolism. Follow up of diagnosed pericardial effusion was performed in 4 patients due to moderate amount and in 3 patients with massive pericardial effusion for fear of cardiac tamponade. Follow up echocardiography was done after pericardiocentesis in 2 patients.
- Intravenous fluids were discontinued in 10 patients due to echocardiographic evidence of ischemic cardiomyopathy with severely reduced LV systolic function, in 6 patients due to dilated cardiomyopathy, and in 3 patients due to tight MS in rheumatic heart disease.
- Anticoagulants were discontinued in 2 patients due to diagnosis of infective endocarditis and in one patient after exclusion of lower limb DVT. Anti-arrhythmic was discontinued in one case due to detection of right atrial thrombus. Inotropics were discontinued in one patient due to severe aortic stenosis.
- The most common echocardiographic abnormalities found in COPD patients were pulmonary hypertension in 52/89 patients (58.4%) and ischemic cardiomyopathy in 14/89 patients (15.7%).
- Also, the most common echocardiographic abnormalities detected in patients with pneumonia were pulmonary hypertension in 17/60 patients (28.3%) and ischemic cardiomyopathy in 9/60 patients (15%).
- The most common echocardiographic abnormality detected in patients with post tuberculous pulmonary fibrosis was pulmonary hypertension in 9/22 patients (40.9).
- Comparison between basic echo findings as done by investigator (pulmonologist) and standard echo findings as done by expert (cardiologist) showed that; there is no significant difference in proportion in each category (basic echo and standard echo) except in probable incompetence of tricuspid valve and probable normal tricuspid valve; P value <0.0001. This mean that only in probable incompetence of tricuspid valve and probable normal tricuspid valve, the standard echo had the upper hand.
- The basic echocardiography at probable incompetence of tricuspid valve reading had the minimum sensitivity, NPV, and ACC level, 30, 63 and 68% respectively, even with 100% PPV and specificity, while in probable normal tricuspid valve it showed minimum PPV, specificity and ACC, 63, 30 and 68% respectively, even with 100% sensitivity and NPV.
- The mean sensitivity of basic echo in detection of all parameter included in echocardiography was 93% with SD 14% and rang of (30-100%), specificity mean 97% with SD 12% and ranged from (30-100%). Also, the ability of basic echo for positive prediction (PPV) and NPV varied from (63-100%). Finally; the accuracy of basic echo ranged from 68%-100%.
- All three echocardiograic views (apical, parasternal and subcostal) were feasible in 139/300 patients (46.3%). Two views (apical and parasternal) were lacking and only one view (subcostal) was obtained in 147/300 patients (49%) due to COPD in 114 patients and tachypnea in 33 patients. Subcostal view was lacking in 14/300 patients (4.7%) due to obesity and excessive intra-abdominal bowel gases.