Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

Handheld Echocardiography in a Clinical Practice Scenario: Concordances Compared to Standard Echocardiographic Reports

  • Gustavo Gavazzoni Blume (Division of Cardiovascular Diseases, Pontificial Catholic University of Parana) ;
  • Luka David Lechinewski (Graphic Methods Sector, Holy House of Curitiba) ;
  • Isabela Pedroza Vieira (Graphic Methods Sector, Holy House of Curitiba) ;
  • Nadine Clausell (Division of Cardiovascular Diseases, Federal University of Rio Grande do Sul) ;
  • Giovana Paludo Bertinato (Division of Cardiovascular Diseases, Pontificial Catholic University of Parana) ;
  • Paulo Andre Bispo Machado-Junior (Division of Cardiovascular Diseases, Pontificial Catholic University of Parana) ;
  • Pedro Goulart Berro (Division of Cardiovascular Diseases, Pontificial Catholic University of Parana) ;
  • Lidia Ana Zytynski Moura (Division of Cardiovascular Diseases, Pontificial Catholic University of Parana) ;
  • Teresa Tsang (Division of Cardiovascular Diseases, University of British Columbia)
  • Received : 2020.12.23
  • Accepted : 2021.05.10
  • Published : 2022.01.27
Download PDF
⟨ Previous Next ⟩

Abstract

BACKGROUND: The purpose of this study was to assess the utility of a handheld device (HH) used during common daily practice and its agreement with the results of a standard echocardiography study (STD) performed by experienced sonographers and echocardiographer. METHODS: A prospective follow-up was conducted in an adult outpatient echocardiography clinic. Experienced sonographers performed the STD and an experienced echocardiographer performed the HH. STD included 2-dimensional images, Doppler and hemodynamics analysis. Hemodynamic assessment was not performed with the HH device because the HH does not include such technology. The images were interpreted by blinded echocardiographers, and the agreement between the reports was analyzed. RESULTS: A total of 108 patients were included; and the concordance for left ventricle (LV) ejection fraction (EF), wall motion score index, LV and right ventricle (RV) function, RV size, and mitral and aortic stenosis was excellent with κ values greater than 0.80. Wall motion abnormalities had good concordance (κ value 0.78). The agreement for LV hypertrophy, mitral and aortic regurgitation was moderate, and tricuspid and pulmonary regurgitation agreements were low (κ values of 0.26 and 0.25, respectively). CONCLUSIONS: In a daily practice scenario with experienced hands, HH demonstrated good correlation for most echocardiography indications, such as ventricular size and function assessment and stenosis valve lesion analyses.

Keywords

References

  1. Badano LP, Nucifora G, Stacul S, et al. Improved workflow, sonographer productivity, and cost-effectiveness of echocardiographic service for inpatients by using miniaturized systems. Eur J Echocardiogr 2009;10:537-42.
  2. Douglas PS, Khandheria B, Stainback RF, et al. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol 2007;50:187-204.
  3. Popescu BA, Andrade MJ, Badano LP, et al. European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography. Eur J Echocardiogr 2009;10:893-905.
  4. Abe Y, Ito M, Tanaka C, et al. A novel and simple method using pocket-sized echocardiography to screen for aortic stenosis. J Am Soc Echocardiogr 2013;26:589-96.
  5. Andersen GN, Haugen BO, Graven T, Salvesen O, Mjolstad OC, Dalen H. Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur J Echocardiogr 2011;12:665-70.
  6. Brennan JM, Blair JE, Goonewardena S, et al. A comparison by medicine residents of physical examination versus hand-carried ultrasound for estimation of right atrial pressure. Am J Cardiol 2007;99:1614-6.
  7. Cardim N, Fernandez Golfin C, Ferreira D, et al. Usefulness of a new miniaturized echocardiographic system in outpatient cardiology consultations as an extension of physical examination. J Am Soc Echocardiogr 2011;24:117-24.
  8. Filipiak-Strzecka D, John B, Kasprzak JD, Michalski B, Lipiec P. Pocket-size echocardiograph--a valuable tool for nonexperts or just a portable device for echocardiographers? Adv Med Sci 2013;58:67-72.
  9. Kobal SL, Atar S, Siegel RJ. Hand-carried ultrasound improves the bedside cardiovascular examination. Chest 2004;126:693-701.
  10. Kono Y, Fukuda S, Shimada K, et al. Pocket-sized echo for evaluation of mitral and tricuspid regurgitation. JACC Cardiovasc Imaging 2011;4:921.
  11. Panoulas VF, Daigeler AL, Malaweera AS, et al. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging 2013;14:323-30.
  12. Vignon P, Chastagner C, Francois B, et al. Diagnostic ability of hand-held echocardiography in ventilated critically ill patients. Crit Care 2003;7:R84-91.
  13. Bruce CJ, Montgomery SC, Bailey KR, Tajik J, Seward JB. Utility of hand-carried ultrasound devices used by cardiologists with and without significant echocardiographic experience in the cardiology inpatient and outpatient settings. Am J Cardiol 2002;90:1273-5.
  14. Culp BC, Mock JD, Chiles CD, Culp WC Jr. The pocket echocardiograph: validation and feasibility. Echocardiography 2010;27:759-64.
  15. Decara JM, Kirkpatrick JN, Spencer KT, et al. Use of hand-carried ultrasound devices to augment the accuracy of medical student bedside cardiac diagnoses. J Am Soc Echocardiogr 2005;18:257-63.
  16. Egan M, Ionescu A. The pocket echocardiograph: a useful new tool? Eur J Echocardiogr 2008;9:721-5.
  17. Evangelista A, Galuppo V, Mendez J, et al. Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation. Heart 2016;102:376-82.
  18. Frederiksen CA, Juhl-Olsen P, Larsen UT, Nielsen DG, Eika B, Sloth E. New pocket echocardiography device is interchangeable with high-end portable system when performed by experienced examiners. Acta Anaesthesiol Scand 2010;54:1217-23.
  19. Fukuda S, Shimada K, Kawasaki T, et al. Pocket-sized transthoracic echocardiography device for the measurement of cardiac chamber size and function. Circ J 2009;73:1092-6.
  20. Kimura BJ, Amundson SA, Shaw DJ. Hospitalist use of hand-carried ultrasound: preparing for battle. J Hosp Med 2010;5:163-7.
  21. Kimura BJ, Demaria AN. Empowering physical examination: the "laying on" of ultrasound. JACC Cardiovasc Imaging 2008;1:602-4.
  22. Kimura BJ, Gilcrease GW 3rd, Showalter BK, Phan JN, Wolfson T. Diagnostic performance of a pocket-sized ultrasound device for quick-look cardiac imaging. Am J Emerg Med 2012;30:32-6.
  23. Kitada R, Fukuda S, Watanabe H, et al. Diagnostic accuracy and cost-effectiveness of a pocket-sized transthoracic echocardiographic imaging device. Clin Cardiol 2013;36:603-10.
  24. Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 2010;23:1225-30.
  25. Liebo MJ, Israel RL, Lillie EO, Smith MR, Rubenson DS, Topol EJ. Is pocket mobile echocardiography the next-generation stethoscope? A cross-sectional comparison of rapidly acquired images with standard transthoracic echocardiography. Ann Intern Med 2011;155:33-8.
  26. Michalski B, Kasprzak JD, Szymczyk E, Lipiec P. Diagnostic utility and clinical usefulness of the pocket echocardiographic device. Echocardiography 2012;29:1-6.
  27. Mjolstad OC, Dalen H, Graven T, Kleinau JO, Salvesen O, Haugen BO. Routinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department. Eur J Intern Med 2012;23:185-91.
  28. Nelson BP, Sanghvi A. Point-of-care cardiac ultrasound: feasibility of performance by noncardiologists. Glob Heart 2013;8:293-7.
  29. Prinz C, Voigt JU. Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr 2011;24:111-6.
  30. Razi R, Estrada JR, Doll J, Spencer KT. Bedside hand-carried ultrasound by internal medicine residents versus traditional clinical assessment for the identification of systolic dysfunction in patients admitted with decompensated heart failure. J Am Soc Echocardiogr 2011;24:1319-24.
  31. Roelandt JR. Ultrasound stethoscopy: a renaissance of the physical examination? Heart 2003;89:971-3.
  32. Vourvouri EC, Poldermans D, Deckers JW, Parharidis GE, Roelandt JR. Evaluation of a hand carried cardiac ultrasound device in an outpatient cardiology clinic. Heart 2005;91:171-6.
  33. Cullen MW, Blauwet LA, Vatury OM, et al. Diagnostic capability of comprehensive handheld vs transthoracic echocardiography. Mayo Clin Proc 2014;89:790-8.
  34. Singh S, Bansal M, Maheshwari P, et al. American Society of Echocardiography: Remote Echocardiography with Web-Based Assessments for Referrals at a Distance (ASE-REWARD) study. J Am Soc Echocardiogr 2013;26:221-33.
  35. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005;37:360-3.
  36. Kobal SL, Trento L, Baharami S, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol 2005;96:1002-6.
  37. Galderisi M, Santoro A, Versiero M, et al. Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study. Cardiovasc Ultrasound 2010;8:51.
  38. Martin LD, Howell EE, Ziegelstein RC, et al. Hand-carried ultrasound performed by hospitalists: does it improve the cardiac physical examination? Am J Med 2009;122:35-41.
  39. Amini R, Stolz LA, Javedani PP, et al. Point-of-care echocardiography in simulation-based education and assessment. Adv Med Educ Pract 2016;7:325-8.
  40. Kennedy Hall M, Coffey EC, Herbst M, et al. The "5Es" of emergency physician-performed focused cardiac ultrasound: a protocol for rapid identification of effusion, ejection, equality, exit, and entrance. Acad Emerg Med 2015;22:583-93.
  41. Becker DM, Tafoya CA, Becker SL, Kruger GH, Tafoya MJ, Becker TK. The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health 2016;21:294-311.