Multi-step Web-based Training: the Road to Stress Echo 2020

Introduccion: Una plataforma de entrenamiento estandarizada ayuda a armonizar la lectura de la ecocardiografia de estres (EE) mas alla de las anormalidades en la motilidad parietal regional (AMPR) Objetivo: Armonizar los criterios de lectura del EE a traves de diferentes laboratorios. Metodos: El laboratorio central preparo para los lectores de ecocardiografia un modulo obligatorio de 5 parametros basado en la web de 2 horas de duracion: AMPR; lineas B, reserva de la velocidad de flujo coronario (RVFC) evaluada mediante la velocidad pico del flujo diastolico en la arteria coronaria descendente anterior; reserva contractil ventricular izquierda (RCVI, evaluada a partir de mediciones crudas del volumen de fin de sistole, VFS); y presion sistolica de la arteria pulmonar (basada en mediciones crudas de la velocidad del jet de regurgitacion tricuspidea, VRT). La prueba de control de calidad consistio en 20 casos seleccionados por el centro coordinador. El umbral de aprobacion determinado a priori fue de 18/20 (≥ 90%) con un coeficiente de correlacion intraclase entre el laboratorio coordinador y el lector periferico > 0.90 Resultados: Ochenta y cuatro lectores completaron la certificacion para las AMPR, 65 para las lineas B, 30 para la RVFC, 24 para el VFS y 20 para la VRT. El tiempo de lectura medio por intento fue mas corto para la VRT (9 ± 4 min), la RVFC (13 ± 6 min) y las lineas B (17 ± 3 min), intermedio para el VFS (24 ± 7 min), y mas prolongado para las AMPR (29 ± 12 min, p < 0.01). La tasa de acierto del primer intento fue mas alta para la RVFC (85%), intermedia para la VRT (75%) y las lineas B (43%), menor para el VFS (35%) y mas baja para las AMPR (28%, p < 0.01). Conclusiones: La plataforma de aprendizaje basada en la web mejora las habilidades de interpretacion de imagenes sin necesidad de un equipamiento de imagenes costoso o de estudiar un paciente. El camino hacia la certificacion es mas largo para las AMPR, intermedio para el VFS y mas corto para la VRT, la RVFC y las lineas B.

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