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Fiabilidad diagnóstica de la ecocardioscopia realizada por un residente no cardiólogo
Accuracy of cardiac ultrasound performed by a noncardiologist resident
Miguel Ángel López Zúñigaa,
Autor para correspondencia
miguelangellopezzuniga@gmail.com

Autor para correspondencia.
, Miriam A. Martín Torob, Tomás Vallejo Palominoc, Alba M. Castillo Fernándeza, Álvaro Campos Caleroa, Ascensión M. Vílchez Parrasa, María I. Villa Garcíaa, Desirée V. Gerez Neiraa, Justo Martinez Colmeneroa, Francisco Padilla Morenoa
a Servicio de Medicina Interna, Complejo Hospitalario de Jaén, Jaén, España
b Servicio de Cardiología, Complejo Hospitalario de Jaén, Jaén, España
c Servicio de Radiología, Complejo Hospitalario de Jaén, Jaén, España
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en diferentes escenarios cl&#237;nicos&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio prospectivo observacional&#44; que incluy&#243; a pacientes consecutivos hospitalizados en un servicio de medicina interna a los que se les solicit&#243; un ecocardiograma reglado programado seg&#250;n indicaci&#243;n cl&#237;nica&#46; Se incluy&#243; a 200 pacientes&#44; de los cuales 15 &#40;7&#44;5&#37;&#41; fueron p&#233;rdidas &#40;2 exitus&#44; 5 dados de alta previa a la realizaci&#243;n de ETT y en 8 se desconoce el motivo&#41;&#46; A los 185 restantes&#44; un m&#233;dico residente de medicina interna&#44; con una formaci&#243;n b&#225;sica en ecograf&#237;a cl&#237;nica&#44; realiz&#243; una ecocardioscopia &#40;con un dispositivo Vscan con sonda Dual&#44; General Electric&#41;&#46; Los resultados fueron comparados con el resultado del ecocardiograma reglado realizado por un cardi&#243;logo en las 48<span class="elsevierStyleHsp" style=""></span>h previas o posteriores&#44; compar&#225;ndose par&#225;metros funcionales y estructurales&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las ecocardiograf&#237;as se solicitaron con motivo de insuficiencia cardiaca congestiva &#40;37&#44;1&#37;&#41;&#44; disnea de origen incierto &#40;14&#44;1&#37;&#41;&#44; s&#237;ndrome febril sin foco &#40;8&#44;8&#37;&#41;&#44; en el 5&#44;3&#37; por sospecha de hipertensi&#243;n pulmonar&#44; y menos del 5&#37; por inicio de fibrilaci&#243;n auricular&#44; s&#237;ncope o dolor tor&#225;cico&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describe la concordancia y la capacidad diagn&#243;stica de la ecocardioscopia comparada con el estudio reglado&#46; Se objetiv&#243; una buena o muy buena concordancia &#40;k<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;61&#41;&#44; una sensibilidad y especificidad &#62;<span class="elsevierStyleHsp" style=""></span>90&#37; y una J de Youden &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;6 en gran parte de los par&#225;metros analizados&#44; incluyendo los par&#225;metros de mayor utilidad cl&#237;nica como la fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo y derecho&#44; la presencia de derrame peric&#225;rdico&#44; la presencia de hipertrofia del ventr&#237;culo izquierdo&#44; el di&#225;metro de la vena cava inferior y la ausencia de una valvulopat&#237;a significativa&#44; as&#237; como la dilataci&#243;n de la ra&#237;z a&#243;rtica&#44; entre otros&#46; Dado que el objetivo principal de esta t&#233;cnica es diferenciar la normalidad de las situaciones patol&#243;gicas&#44; esta capacidad queda refrendada por la presencia de un valor predictivo negativo del 80&#37; en casi la totalidad de los par&#225;metros estudiados&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">La baja prevalencia del car&#225;cter observado y la asimetr&#237;a de los totales marginales&#44; influyen de manera limitante en el valor del &#237;ndice kappa<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#44; por lo que&#44; ante una prevalencia baja&#44; adquieren mayor importancia&#44; si cabe&#44; los resultados obtenidos&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los datos presentados son ligeramente inferiores a los obtenidos por L&#243;pez-Palmero et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> &#40;internistas&#41; o Prinz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> &#40;cardi&#243;logos&#41;&#44; muy probablemente debido a una mayor experiencia de estos profesionales y a la variabilidad en la indicaci&#243;n de la ecocardiograf&#237;a que presenta este estudio respecto a los anteriores&#44; hecho que promueve una baja prevalencia&#44; y las consecuencias de esta sobre el valor kappa&#44; como ya se ha comentado con anterioridad&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A la vista de estos resultados&#44; la ecocardioscopia&#44; llevada a cabo por &#171;no cardi&#243;logos&#187; con una curva de aprendizaje breve&#44; debe interpretarse como una herramienta de selecci&#243;n fiable&#44; lo cual permitir&#237;a al cl&#237;nico mejorar el rendimiento diagn&#243;stico&#46; Siempre&#44; tras un periodo de formaci&#243;n espec&#237;fico y sin poder sustituir a la ecocardiograf&#237;a reglada llevada a cabo por cardi&#243;logos en los casos en que sean necesarios un diagn&#243;stico concreto definitivo&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">De esta manera&#44; el uso de la ecocardioscopia puede postularse como un quinto pilar de la exploraci&#243;n f&#237;sica&#44; &#250;til a la hora de valorar al paciente&#46; Podemos concluir que un residente puede incorporar la ecocardioscopia de forma fiable a la exploraci&#243;n f&#237;sica tras un periodo de formaci&#243;n limitado&#46;</p></span>"
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                  \t\t\t\t">Tric&#250;spide sin afectaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;68 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">IT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;68 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Tric&#250;spide met&#225;lica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Dilataci&#243;n VD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;65 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Di&#225;metro VCI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ra&#237;z a&#243;rtica dilatada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Derrame peric&#225;rdico&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00257753
Idioma original: Español
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