超声增强剂研究需求识别（IN-USE 研究）。
Identification of Need for Ultrasound Enhancing Agent Study (the IN-USE Study).
机构信息
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
出版信息
J Am Soc Echocardiogr. 2020 Dec;33(12):1500-1508. doi: 10.1016/j.echo.2020.07.015. Epub 2020 Sep 9.
BACKGROUND
Ultrasound enhancing agents (UEAs) are routinely used to improve transthoracic echocardiographic (TTE) image quality, yet anticipation of UEA need is a barrier to their use.
METHODS
Structured report data from 171,509 consecutive TTE studies in 97,515 patients who underwent TTE imaging from January 26, 2000, to September 20, 2018, were analyzed. Trends in UEA use and suboptimal image quality were examined. Among outpatients (92,291 TTE examinations, n = 56,479), the data set was randomly split into a 75% derivation sample and a 25% validation sample. Logistic regression was used to model the composite of either UEA receipt or suboptimal image quality (two or more nonvisualized segments) using only variables available at the start of the TTE examination. Model performance was tested in the validation sample.
RESULTS
A total of 4,444 TTE examinations (2.6%) in 3,827 patients (3.9%) involved UEAs, and 28,468 TTE examinations (16.6%) in 21,994 patients (22.5%) were suboptimal. UEA use increased over the observation period. Among TTE studies with suboptimal image quality, UEA use was lower in women (P < .0001). Among outpatients referred for TTE imaging, older age, greater weight, and higher heart rate best predicted UEA use or suboptimal image quality. Model performance in the validation sample was excellent (C statistic = 0.74 [95% CI, 0.73-0.75]; calibration slope = 1.11 [95% CI, 1.06-1.15]).
CONCLUSIONS
In this large, single-center, retrospective study, UEA use remained substantially below rates of suboptimal image quality, despite increases over time. Among outpatients, a simple prediction rule using three routinely collected variables available before TTE image acquisition predicted potential benefit from UEAs with high accuracy. If confirmed in other cohorts, this rule may be used to identify patients who may benefit from intravenous placement for UEA administration before TTE image acquisition, thus potentially improving work-flow efficiency.
背景
超声增强剂（UEA）通常用于提高经胸超声心动图（TTE）的图像质量，但对 UEA 的预期需求是其使用的障碍。
方法
分析了 2000 年 1 月 26 日至 2018 年 9 月 20 日期间进行 TTE 成像的 97515 名患者的 171509 例连续 TTE 研究的结构报告数据。检查了 UEA 使用和图像质量不佳的趋势。在门诊患者（92291 次 TTE 检查，n=56479）中，数据集随机分为 75%的推导样本和 25%的验证样本。使用 TTE 检查开始时仅有的变量，使用逻辑回归对 UEA 接受或图像质量不佳（两个或更多不可见段）的复合进行建模。在验证样本中测试模型性能。
结果
共有 4444 次 TTE 检查（2.6%）涉及 3827 名患者（3.9%）使用 UEA，28468 次 TTE 检查（16.6%）涉及 21994 名患者（22.5%）图像质量不佳。在观察期间，UEA 的使用有所增加。在图像质量不佳的 TTE 研究中，女性使用 UEA 的比例较低（P<.0001）。在因 TTE 成像而就诊的门诊患者中，年龄较大、体重较大和心率较高是 UEA 使用或图像质量不佳的最佳预测因素。验证样本中的模型性能非常好（C 统计量=0.74 [95%CI，0.73-0.75]；校准斜率=1.11 [95%CI，1.06-1.15]）。
结论
在这项大型的单中心回顾性研究中，尽管 UEA 的使用随着时间的推移而增加，但仍大大低于图像质量不佳的比例。在门诊患者中，使用三个在 TTE 图像采集前常规收集的变量构建的简单预测规则，可以准确预测 UEA 的潜在获益。如果在其他队列中得到证实，该规则可用于识别可能从 TTE 图像采集前静脉放置 UEA 中获益的患者，从而可能提高工作流程效率。
Zotero 插件