A minimum dataset for a Level 1 echocardiogram: a guideline protocol from the British Society of Echocardiography

Abstract

The British Society of Echocardiography has previously outlined a minimum dataset for a standard transthoracic echocardiogram, and this remains the basis on which an echocardiographic study should be performed. The importance of ultrasound in excluding critical conditions that may require urgent treatment is well known. Several point-of-care echo protocols have been developed for use by non-echocardiography specialists. However, these protocols are often only used in specific circumstances and are usually limited to 2D echocardiography. Furthermore, although the uptake in training for these protocols has been reasonable, there is little in the way of structured support available from accredited sonographers in the ongoing training and re-accreditation of those undertaking these point-of-care scans. In addition, it is well recognised that the provision of echocardiography on a 24/7 basis is extremely challenging, particularly outside of tertiary cardiac centres. Consequently, following discussions with NHS England, the British Society of Echocardiography has developed the Level 1 echocardiogram in order to support the rapid identification of critical cardiac pathology that may require emergency treatment. It is intended that these scans will be performed by non-specialists in echocardiography and crucially are not designed to replace a full standard transthoracic echocardiogram. Indeed, it is expected that a significant number of patients, in whom a Level 1 echocardiogram is required, will need to have a full echocardiogram performed as soon as is practically possible. This document outlines the minimum dataset for a Level 1 echocardiogram. The accreditation process for Level 1 echo is described separately.

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“…These findings were in keeping with our UK single-centre, retrospective observational cohort study of 74 critically unwell adults hospitalised with COVID-19 (41). In a sick cohort in whom the majority needed mechanical ventilation and over half vasopressor support, the primary abnormalities were dilatation of the RV in nearly half (41%) and RV systolic dysfunction (RVSD) in nearly a third (27%) (19).…”

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“…Echocardiography. Echocardiography was performed (Sparq 795090CC or Affinity ultrasound systems, Philips Healthcare, Netherlands, Philips Healthcare, Netherlands) using a phased array S5 probe by experienced, accredited echocardiographers (level 2 proficiency accreditation British Society of Echocardiography (BSE)) following a modified level 1 focused protocol with assessment of chamber size and function, valvular disease and likelihood of pulmonary hypertension [ 16 ].…”

“…Left ventricular size was assessed using the absolute LV end-diastolic dimension according to sex measured in a parasternal long axis view [17]. LV systolic function was assessed visually, as per the BSE level 1 guidance [16].…”

Echocardiographic Findings in Patients With COVID-19 Pneumonia

“…Echocardiography was performed (Sparq 795090CC ultrasound system, Philips Healthcare, Amsterdam, Netherlands) using a phased array S5 probe by experienced, accredited echocardiographers (level 2 proficiency accreditation British Society of Echocardiography [BSE]) following a modified level 1 focused protocol with assessment of chamber size and function, valvular disease, and likelihood of pulmonary hypertension. 1 The BSE level 1 protocol does not require measurements to be performed and does not include tissue Doppler.…”

“…3 Left ventricular (LV) systolic function was assessed visually, as per the BSE level 1 guidance. 1 All patients underwent routine chest radiography. Computed tomography pulmonary angiography was performed in selected cases at the discretion of the clinical team.…”