Mikhayla Azzopardi

University of Sydney,
Australia

Abstract Title: Reliability and Reproducibility of Transthoracic Echocardiography in the Critically Ill: Image Quality Analysis - A Prospective Randomised Single Centre Study

Biography:

Mikhayla Azzopardi is an early career researcher currently working as a junior doctor at John Hunter Hospital in Newcastle, Australia. She completed her MD at the University of Sydney in 2024 and has a keen interest in Critical Care Echocardiography with a hope to pursue Intensive Care Medicine in the future. Mikhayla’s previous experiences include working as a registered Nurse in PICU/NICU and as an Officer in the Australian Regular Army. In her free time Mikhayla volunteers with CanTeen Australia – a charity for young people who’s lives have been effected by cancer.

Research Interest:

Background: Transthoracic echocardiography (TTE) is a commonly used imaging modality in the Intensive care unit (ICU). Scans are performed by sonographers, senior clinicians and trainees depending on the indication and timing. Education, training and experience differs between the three groups and the implication of this on image quality in the critically ill is unknown.

Methods: Single centre prospective randomised study. Patients were recruited from a tertiary hospital general adult ICU. Sonographer and clinician participants were recruited from the ICU and cardiac imaging departments. A focussed TTE was performed by one randomly selected member from each of the groups with each patient having a total of 3 scans. Image quality assessment was performed by an independent clinician using the American College of Cardiology Transthoracic Image Quality assessment tool. Descriptive and inferential (non-parametric) statistical analysis was performed.

Results: 70 patients completed the scanning protocol. The median time between first and last scan was 6 hours. The Kruskal-Wallis one-way analysis of variance and pairwise comparison tests were performed showing significant differences in 11 of 13 domains of the scoring tool (p = <0.05). Image orientation and colour flow Doppler imaging having the largest inter-group score difference. The mean score across all patients for sonographers was 11.02/13, senior clinicians was 9.44/13 and junior clinicians was 8.28/13 (p = <0.001), where a higher score represents better objective image quality.

Conclusion: Using an objective assessment tool, image quality varied significantly between sonographers and clinicians in critically ill adults. Current international guidelines regarding TTE experience and training for ICU clinicians may be insufficient for clinicians needing to make treatment decisions at the bedside based on images they’ve acquired.