Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Virginia Zarama is the recipient of this year's Kellogg College Gillian Nicholls Prize for her MSc in Evidence-Based Health Care dissertation.

A young woman doctor with long hair dressed in scrubs, standing next to a tall red vertical emergency department sign

Virginia is the Emergency Department Academic Director at the Fundación Valle del Lili at Cali, Colombia. She is an emergency physician with extensive experience in trauma and emergency care, including emergency ultrasound and advanced critical care echocardiography.

Commenting on winning the prize, Virginia said:

"I am deeply honored to receive this prestigious prize. My sincere thanks to my supervisors, Dr. James Sheppard and Dr. Annette Plüddemann, for their exceptional guidance and support, and to all the faculty at the Centre for Evidence-Based Medicine for their invaluable contributions to my learning in this field. I would also like to express my gratitude to Dr. Ramiro Manzano and Dr. María Camila Arango, who acted as second reviewers, and to Nia Roberts, Oxford Librarian, whose time and effort enhanced the quality and rigor of this systematic review. I want to give a special mention to Fundación Valle del Lili, my hospital, for consistently supporting and encouraging me to achieve my highest academic goals. My sincere thanks also to Kellogg College and the donor of this prize. And finally, my infinite gratitude to my family who have had a profound effect on my life and continuously push me to reach my fullest potential with unconditional love and support.” 

Virginia’s dissertation entitled The Diagnostic Accuracy of Cardiac Ultrasound for Acute Myocardial Ischemia in the Emergency Department: A Systematic Review and Meta-analysis is summarised below: 

'Chest pain is one of the most common reasons for adults to present to the emergency department (ED), with millions of visits each year. It can be caused by a wide range of diseases from life-threatening conditions such as myocardial infarction, aortic or pulmonary diseases, to more benign and harmless entities, making it a diagnostic challenge for emergency physicians.

Cardiac ultrasound is superior to physical examination in correctly identifying most cardiovascular conditions.  Furthermore, clinical examination assisted by a focused cardiac ultrasound has more than a 40% increase in the ability to correctly identify those who have cardiac dysfunction and valvular disease. Smaller, portable ultrasound devices and advanced training now allow health professionals to perform cardiac ultrasound right at the bedside in the ED.

 When a decrease in blood flow to the heart occurs, like in myocardial ischemia and infarction, changes in cardiac regional wall motion can be visualized by ultrasound within seconds. The presence or absence of these motion changes in patients with chest pain can provide useful information, giving cardiac ultrasound a potential role in the early detection of myocardial ischemia in patients with chest pain.

 Therefore, the goal of this dissertation was twofold. First, it aimed to conduct a systematic review to determine how accurately cardiac ultrasound can diagnose acute myocardial ischemia in ED patients with chest pain. Second, it sought to understand how this accuracy is influenced by patient characteristics, clinical conditions, and ultrasound technical details.

The search found 29 relevant studies with a total of 5,304 patients that were combined and analyzed together. Cardiac ultrasound was found to be moderately accurate for the diagnosis of myocardial ischemia in the ED. However, the estimated accuracy varied significantly in different subgroups. For instance, there was an increased sensitivity in studies where ultrasound was conducted immediately at ED admission and increased specificity (test's ability to correctly identify those who do not have the disease) in studies that excluded patients with previous heart disease. The evidence was considered of very low certainty based on the low methodological quality of most studies.

The results of this research help clarify the diagnostic characteristics of cardiac ultrasound for acute myocardial ischemia in patients with chest pain in the ED, emphasizing how specific clinical factors (like patient’s previous heart disease and the timing when the ultrasound is conducted) likely affect its diagnostic performance and should be taken into consideration when interpreting its findings. It also underscores the potential role of cardiac ultrasound in the assessment of these patients, especially early on ED admission, and possibly as an add-on test to the current diagnostic pathway where future well-designed research is needed.'



Contact our communications team

Opinions expressed are those of the authors and not of Oxford University. Readers' comments will be moderated - see our guidelines for further information.