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Published in: The International Journal of Cardiovascular Imaging 5/2023

21-01-2023 | Echocardiography | Original Paper

Reasons for disagreement between screening and standard echocardiography in primary care: data from the PROVAR + study

Disagreement between screening and standard echo

Authors: Bruno F. Galdino, Arthur M. Amaral, Luiza P. A. Santos, Marcelo Augusto A. de Nogueira, Rodrigo T. L. Rocha, Maria Carmo P. Nunes, Andrea Z. Beaton, Kaciane K. B. Oliveira, Juliane Franco, Márcia M. Barbosa, Victor R. H. Silva, Alison T. Reese, Antonio Luiz P. Ribeiro, Craig A. Sable, Bruno R. Nascimento, On behalf of the PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática e outras Doenças Cardiovasculares) investigators

Published in: The International Journal of Cardiovascular Imaging | Issue 5/2023

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Abstract

We aimed to evaluate the reasons for disagreement between screening echocardiography (echo), acquired by nonexperts, and standard echo in the Brazilian primary care (PC). Over 20 months, 22 PC workers were trained on simplified handheld (GE VSCAN) echo protocols. Screening groups, consisting of patients aged 17-20, 35-40 and 60-65 years, and patients referred for clinical indications underwent focused echo. Studies were remotelyinterpreted in US and Brazil, and those diagnosed with major or severe HD were referred for standard echoperformed by an expert. Major HD was defined as moderate to severe valve disease, ventriculardysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A random sample of exams wasselected for evaluation of variables accounting for disagreement. A sample of 768 patients was analyzed, 651(85%) in the referred group. Quality issues were reported in 5.8%, and the random Kappa for major HD between screening and standard echo was 0.51. The most frequent reasons for disagreement were: overestimation of mitral regurgitation (MR) (17.9%, N=138), left ventricular (LV) dysfunction (15.7%, N=121), aortic regurgitation (AR) (15.2%, N=117), LV hypertrophy (13.5%, N=104) and tricuspid regurgitation (12.7%, N=98). Misdiagnosis of mitral and aortic morphological abnormalities was observed in 12.4% and 3.0%, and underestimation of AR and MR occurred in 4.6% and 11.1%. Among 257 patients with suspected mild/moderate MR, 129 were reclassified to normal. In conclusion, although screening echo with task-shifting in PC is a promising tool in low-income areas, estimation of valve regurgitation and LV function and size account for considerable disagreement with standard exams.
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Metadata
Title
Reasons for disagreement between screening and standard echocardiography in primary care: data from the PROVAR + study
Disagreement between screening and standard echo
Authors
Bruno F. Galdino
Arthur M. Amaral
Luiza P. A. Santos
Marcelo Augusto A. de Nogueira
Rodrigo T. L. Rocha
Maria Carmo P. Nunes
Andrea Z. Beaton
Kaciane K. B. Oliveira
Juliane Franco
Márcia M. Barbosa
Victor R. H. Silva
Alison T. Reese
Antonio Luiz P. Ribeiro
Craig A. Sable
Bruno R. Nascimento
On behalf of the PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática e outras Doenças Cardiovasculares) investigators
Publication date
21-01-2023
Publisher
Springer Netherlands
Published in
The International Journal of Cardiovascular Imaging / Issue 5/2023
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-023-02800-6

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