Medicine (Northwest Academic Centre) - Theses
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ItemTranslation of established and advanced echocardiographic imaging techniques and novel imaging protocols to enhance diagnostic value and appropriate use in the new cardiovascular epidemic( 2021)Despite improved strategies leading to a significant decline in the rate of myocardial infarctions, there is an emerging cardiovascular epidemic comprising of heart failure, aortic stenosis, and atrial fibrillation. This is driven by the rise in life expectancy and other comorbidities and cardiovascular risk factors, including hypertension, smoking, diabetes, obesity, and physical inactivity. These diseases carry a high rate of morbidity and mortality, and they also place a tremendous burden on our health system. Cardiovascular disease represents 15 % of the total burden of diseases in Australia which is only second to cancer. Continued gains in maintaining the quality of life and preventing acute decompensation in these illnesses will be assisted by the effective translation of emerging technologies in cardiac imaging into earlier clinical decision-making to prevent disease progression. These applications will not only be dependent on imaging at baseline, but also on follow-up. This presents clinical challenges in terms of the quality control of imaging, as well as its growth - in Australia, cardiac imaging continues to grow at approximately 10% per year. In view of the preceding background, the themes and research questions for this thesis will focus on the application and utilization of the latest advances in echocardiography: Theme A: testing new echo tools to improve early diagnosis and clinical decision making. Theme B: patient selection for diagnostic echocardiography to reduce inappropriate testing. Theme C: peer review of image interpretation and quality control through online-based training. This thesis consists of a number of studies. The first study is based on results from a randomized trial which was conducted in a single tertiary centre in Melbourne. As part of the NIL-CHF trial cardiac inpatients aged greater than 45 years were screened for study eligibility including any cardiovascular diagnosis excluding HF. After baseline history and Charlson Comorbidity Index were assessed, a transthoracic echocardiogram was performed, and LV strain analysis was performed offline. Extended follow-up was organised via data linkage, and analyses included: 1. Evaluation of a novel imaging LV strain as a predictor of heart failure in a cohort of stage A and B heart failure? 2. Evaluation of a novel imaging LV strain as a predictor of heart failure in coronary artery disease? We also conducted three prospective trials based on appropriate patient selection for echocardiography and image interpretation (quality control studies): 3. Evaluation of a new handheld ultrasound protocol to address the issue of inappropriate echocardiography. 4. Evaluation of web-enabled teaching to address interobserver variability in the assessment of aortic stenosis. 5. Evaluation of web-enabled teaching to address interobserver variability in the assessment of left atrial function.