1
|
Allimant P, Guillo L, Fierling T, Rabiaza A, Cibois-Honnorat I. Point-of-care ultrasound to assess left ventricular ejection fraction in heart failure in unselected patients in primary care: a systematic review. Fam Pract 2025; 42:cmae040. [PMID: 39162139 DOI: 10.1093/fampra/cmae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Heart failure (HF) is the most frequent cardiovascular pathology in primary care. Echocardiography is the gold standard for diagnosis, follow-up, and prognosis of HF. Point-of-care ultrasound (POCUS) is of growing interest in daily practice. AIM This study aimed to systematically review the literature to evaluate left ventricular ejection fraction (LVEF) assessment of unselected patients in primary care by non-expert physicians with cardiac POCUS (cPOCUS). METHODS We searched in Medline, Embase, and Pubmed up to January 2024 for interventional and non-interventional studies assessing LVEF with cPOCUS in unselected patients with suspected or diagnosed HF in hospital or outpatient settings, performed by non-expert physicians. RESULTS Forty-two studies were included, involving 6598 patients, of whom 60.2% were outpatients. LVEF was assessed by 351 non-expert physicians after an initial ultrasound training course. The LVEF was mainly assessed by visual estimation (90.2%). The most frequent views were parasternal long/short axis, and apical 4-chamber. The median time of cPOCUS was 8 minutes. A strong agreement was found (κ = 0.72 [0.63; 0.83]) compared to experts when using different types of ultrasound devices (hand-held and standard), and agreement was excellent (κ = 0.84 [0.71; 0.89]) with the same device. Training course combined a median of 4.5 hours for theory and 25 cPOCUS for practice. CONCLUSION The use of cPOCUS by non-expert physicians after a short training course appears to be an accurate complementary tool for LVEF assessment in daily practice. Its diffusion in primary care could optimize patient management, without replacing specialist assessment.
Collapse
Affiliation(s)
- Perrine Allimant
- Department of General Medicine, University of Aix-Marseille, Marseille, France
| | - Lucas Guillo
- Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France
| | - Thomas Fierling
- Department of General Medicine, CERESS, University of Aix-Marseille University, Marseille, France
| | - Andry Rabiaza
- Department of General Medicine, UNICAEN, University of Caen Normandy, Caen, France
| | | |
Collapse
|
2
|
Teira Calderón A, Levine M, Ruisánchez C, Serrano D, Catoya S, Llano M, Lerena P, Cuesta JM, Fernández-Valls M, González Vilchez F, de la Torre Hernández JM, García-García HM, Vazquez de Prada JA. Clinical comparison of a handheld cardiac ultrasound device for the assessment of left ventricular function. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:55-64. [PMID: 37882957 DOI: 10.1007/s10554-023-02979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Recently developed handheld ultrasound devices (HHUD) represent a promising method to evaluate the cardiovascular abnormalities at the point of care. However, this technology has not been rigorously evaluated. The aim of this study was to explore the correlation and the agreement between the LVEF (Left Ventricular Ejection Fraction) visually assessed by a moderately experienced sonographer using an HHUD compared to the routine LVEF assessment performed at the Echocardiography Laboratory. METHODS This was a prospective single center study which enrolled 120 adult inpatients and outpatients referred for a comprehensive Echocardiography (EC). RESULTS The mean age of the patients was 69.9 ± 12.5 years. There were 47 females (39.2%). The R-squared was r 0.94 (p < 0.0001) and the ICC was 0.93 (IC 95% 0.91-0.95, p ≤ 0.0001). The Bland-Altman plot showed limits of agreement (LOA): Upper LOA 10.61 and Lower LOA - 8.95. The overall agreement on the LVEF assessment when it was stratified as "normal" or "reduced" was 89.1%, with a kappa of 0.77 (p < 0.0001). When the LVEF was classified as "normal", "mildly reduced", "moderately reduced", or "severely reduced," the kappa was 0.77 (p < 0.0001). The kappa between the HHUD EC and the comprehensive EC for the detection of RWMAs in the territories supplied by the LAD, LCX and RCA was 0.85, 0.73 and 0.85, respectively. CONCLUSION With current HHUD, an averagely experienced operator can accurately bedside visual estimate the LVEF. This may facilitate the incorporation of this technology in daily clinical practice improving the management of patients.
Collapse
Affiliation(s)
- Andrea Teira Calderón
- Hospital Universitari i Politécnic La Fe, Valencia (Valencia), España.
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España.
| | - Molly Levine
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Cristina Ruisánchez
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - David Serrano
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Santiago Catoya
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Miguel Llano
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Piedad Lerena
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - José María Cuesta
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Mónica Fernández-Valls
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Francisco González Vilchez
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Jose María de la Torre Hernández
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Héctor M García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Jose Antonio Vazquez de Prada
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| |
Collapse
|
3
|
Jenkins S, Alabed S, Swift A, Marques G, Ryding A, Sawh C, Wardley J, Shah BN, Swoboda P, Senior R, Nijveldt R, Vassiliou VS, Garg P. Diagnostic accuracy of handheld cardiac ultrasound device for assessment of left ventricular structure and function: systematic review and meta-analysis. Heart 2021; 107:1826-1834. [PMID: 34362772 PMCID: PMC8562308 DOI: 10.1136/heartjnl-2021-319561] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Handheld ultrasound devices (HUD) has diagnostic value in the assessment of patients with suspected left ventricular (LV) dysfunction. This meta-analysis evaluates the diagnostic ability of HUD compared with transthoracic echocardiography (TTE) and assesses the importance of operator experience. Methods MEDLINE and EMBASE databases were searched in October 2020. Diagnostic studies using HUD and TTE imaging to determine LV dysfunction were included. Pooled sensitivities and specificities, and summary receiver operating characteristic curves were used to determine the diagnostic ability of HUD and evaluate the impact of operator experience on test accuracy. Results Thirty-three studies with 6062 participants were included in the meta-analysis. Experienced operators could predict reduced LV ejection fraction (LVEF), wall motion abnormality (WMA), LV dilatation and LV hypertrophy with pooled sensitivities of 88%, 85%, 89% and 85%, respectively, and pooled specificities of 96%, 95%, 98% and 91%, respectively. Non-experienced operators are able to detect cardiac abnormalities with reasonable sensitivity and specificity. There was a significant difference in the diagnostic accuracy between experienced and inexperienced users in LV dilatation, LVEF (moderate/severe) and WMA. The diagnostic OR for LVEF (moderate/severe), LV dilatation and WMA in an experienced hand was 276 (95% CI 58 to 1320), 225 (95% CI 87 to 578) and 90 (95% CI 31 to 265), respectively, compared with 41 (95% CI 18 to 94), 45 (95% CI 16 to 123) and 28 (95% CI 20 to 41), respectively, for inexperienced users. Conclusion This meta-analysis is the first to establish HUD as a powerful modality for predicting LV size and function. Experienced operators are able to accurately diagnose cardiac disease using HUD. A cautious, supervised approach should be implemented when imaging is performed by inexperienced users. This study provides a strong rationale for considering HUD as an auxiliary tool to physical examination in secondary care, to aid clinical decision making when considering referral for TTE. Trial registration number CRD42020182429.
Collapse
Affiliation(s)
- Sam Jenkins
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Andrew Swift
- Cardiovascular and Metabolic Health, Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Gabriel Marques
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Alisdair Ryding
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Chris Sawh
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - James Wardley
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Benoy Nalin Shah
- Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | | | - Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Robin Nijveldt
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Pankaj Garg
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| |
Collapse
|
4
|
Marbach JA, Almufleh A, Di Santo P, Simard T, Jung R, Diemer G, West FM, Millington SJ, Mathew R, Le May MR, Hibbert B. A Shifting Paradigm: The Role of Focused Cardiac Ultrasound in Bedside Patient Assessment. Chest 2020; 158:2107-2118. [PMID: 32707179 DOI: 10.1016/j.chest.2020.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
Transthoracic echocardiography is the standard of care in anatomic and functional cardiovascular assessment; however, focused cardiac ultrasound (FoCUS) performed with portable ultrasound equipment is increasingly being used as an adjunct to comprehensive history and physical examination. FoCUS assessments, unlike formal echocardiography, are intended to assist physicians in answering explicit clinical questions with a narrow differential diagnosis in real time. Over the past decade, a growing body of literature has repeatedly shown the value that FoCUS adds to clinical evaluation. Specifically, FoCUS improves point-of-care diagnostic accuracy, which in turn modifies treatment plans, decreases time to diagnosis, and reduces resource utilization. Although less robust, there is also evidence showing improvement in clinical outcomes. Based on this evidence, clinicians, training programs, and clinical societies have embraced FoCUS as a tool to complement bedside patient evaluation. Herein, we review the evidence for FoCUS in clinical practice, specifically evaluating the diagnostic accuracy, the impact on clinical decision-making, and the effect on clinical outcomes.
Collapse
Affiliation(s)
- Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Aws Almufleh
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard Jung
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Gretchen Diemer
- Division of Hospital Medicine, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Frances Mae West
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Scott J Millington
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michel R Le May
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
5
|
Guppy-Coles KB, Prasad SB, Smith KC, Lo A, Beard P, Ng A, Atherton JJ. Accuracy of Cardiac Nurse Acquired and Measured Three-Dimensional Echocardiographic Left Ventricular Ejection Fraction: Comparison to Echosonographer. Heart Lung Circ 2019; 29:703-709. [PMID: 31320256 DOI: 10.1016/j.hlc.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/14/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Three-dimensional echocardiography (3D-Echo) performed by novice health care staff to measure left ventricular ejection fraction (LVEF) could allow cost-effective screening and monitoring for left ventricular systolic dysfunction (LVSD) prior to the development of heart failure. The aim of this study was to determine feasibility and accuracy of cardiac nurses (after completing focussed training) independently acquiring 3D-Echo images, and measuring LVEF using semi-automated software when compared to an echosonographer. METHODS One echosonographer and three cardiac nurses acquired 3D-Echo images on 73 patients (62 ± 16 years, 62% male) with good image quality, and subsequently measured LVEF using a semi-automated algorithm. RESULTS Overall feasibility was 89% with the three nurses successfully acquiring 3D-Echo images suitable for LVEF assessment in 65 of the 73 patients. High accuracy (r = 0.82; p < 0.0001) with minimal bias (+0.1, -10.6 to +10.8 limits of agreement; p = 0.91) was observed comparing the nurses to the echosonographer for measuring LVEF. Individual nurses demonstrated high feasibility (86%-92%), accuracy (r = 0.83-0.87; all p < 0.0001) and intra-observer reproducibility (r = 0.96-0.97; all p < 0.0001), with good inter-observer consistency in accuracy compared to the echosonographer (one-way analysis of variance p = 0.559). CONCLUSIONS We have demonstrated that, following a focussed training protocol, it was feasible for cardiac nurses to acquire 3D-Echo images of sufficient image quality to allow measurement of LVEF using a semi-automated algorithm, with comparable accuracy and intra-observer variability to an expert echosonographer. This could potentially allow the broader application of echocardiography to screen for LVSD in high-risk cohorts.
Collapse
Affiliation(s)
- Kristyan B Guppy-Coles
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Sandhir B Prasad
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Kym C Smith
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Ada Lo
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Patrick Beard
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Arnold Ng
- Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.
| |
Collapse
|
6
|
Mullangi S, Sozio SM, Segal P, Menez S, Martire C, Shafi T. Point-of-care ultrasound education to improve care of dialysis patients. Semin Dial 2018; 31:154-162. [PMID: 29314256 PMCID: PMC5839962 DOI: 10.1111/sdi.12664] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Point-of-care ultrasound (POCUS) is rapidly emerging as a bedside diagnostic tool that can enhance physical diagnosis and facilitate clinical decision making. Although ultrasound is widely used by nephrologists for vascular access and kidney imaging, diagnostic POCUS skills in other anatomic areas are not part of routine nephrology training. In this narrative review, we will provide an overview of selected POCUS techniques, highlight potential uses of POCUS in routine nephrology practice, and describe a new curriculum implemented at Johns Hopkins University School of Medicine to teach diagnostic POCUS skills to nephrology fellows.
Collapse
Affiliation(s)
- Surekha Mullangi
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Paul Segal
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Steven Menez
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Carol Martire
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
7
|
Abstract
Though the use of point-of-care ultrasound (POCUS) has increased over the last decade, formal hospital credentialing for POCUS may still be a challenge for hospitalists. This document details the Hospital Medicine Department Ultrasound Credentialing Policy from Regions Hospital, which is part of the HealthPartners organization in Saint Paul, Minnesota. National organizations from internal medicine and hospital medicine (HM) have not published recommended guidelines for POCUS credentialing. Revised guidelines for POCUS have been published by the American College of Emergency Physicians, though these are not likely intended to guide hospitalists when working with credentialing committees and medical boards. This document describes the scope of ultrasound in HM and our training, credentialing, and quality assurance program. This report is intended to be used as a guide for hospitalists as they work with their own credentialing committees and will require modification for each institution. However, the overall process described here should assist in the establishment of POCUS at various institutions.
Collapse
Affiliation(s)
- Benji K Mathews
- Department of Hospital Medicine, HealthPartners, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael Zwank
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Emergency Medicine, Regions Hospital, St. Paul, Minnesota, USA
| |
Collapse
|
8
|
Fiorelli EM, Casella F, Torzillo D, Cogliati C. Bedside focused cardiac ultrasound in the evaluation of systolic dysfunction. Intern Emerg Med 2017; 12:241-245. [PMID: 28063115 DOI: 10.1007/s11739-016-1598-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Elisa Maria Fiorelli
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, via GB Grassi 74, Milan, Italy.
| | - Francesco Casella
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, via GB Grassi 74, Milan, Italy
| | - Daniela Torzillo
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, via GB Grassi 74, Milan, Italy
| | - Chiara Cogliati
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, via GB Grassi 74, Milan, Italy
| |
Collapse
|
9
|
Abstract
Focused cardiac ultrasound (FCU) is a bedside examination of the heart performed with a small, portable ultrasound platform by a physician as an adjunct to their physical examination. The goal is to recognize a narrow list of abnormalities that are both detectable by physicians with limited ultrasound training and have high clinical assessment value. Results from the FCU examination are integrated with traditional bedside assessment (physical examination and history) to provide early management plans and patient triage in settings when echocardiography cannot be obtained or is not immediately available.
Collapse
Affiliation(s)
- Kirk T Spencer
- University of Chicago, 5841 S Maryland MC 5084, Chicago, IL, 60637, USA,
| |
Collapse
|
10
|
Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:567-81. [DOI: 10.1016/j.echo.2013.04.001] [Citation(s) in RCA: 415] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
11
|
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. [DOI: 10.1016/j.echo.2011.07.013] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Indexed: 11/24/2022]
|
12
|
Michalski B, Kasprzak JD, Szymczyk E, Lipiec P. Diagnostic utility and clinical usefulness of the pocket echocardiographic device. Echocardiography 2011; 29:1-6. [PMID: 22044766 DOI: 10.1111/j.1540-8175.2011.01553.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The pocket echocardiograph (PE) with color Doppler imaging belongs to a new class of diagnostic tools, the feasibility and accuracy of which is not well established. The aim of this study was to assess the feasibility and diagnostic value of transthoracic echocardiography (TTE) performed with the use of PE by a cardiology resident (2nd year of training) and by an experienced cardiologist. METHODS The study population comprised 220 consecutive patients (142 men, mean age 63 ± 8 years), 110 of whom were admitted to our intensive cardiac care unit (ICU) and 110 patients referred for TTE from the outpatient clinic. All patients had PE TTE performed by a resident (60 ICU patients, 60 outpatients) or a cardiologist (50 ICU patients, 50 outpatients). Within 24 h of PE TTE, all subjects had a standard TTE (sTTE) performed by an experienced echocardiographer. RESULTS 96% of patients had echocardiographic measurements completed by both PE TTE and sTTE. The dimensions measured with PE TTE by the resident and the cardiologist showed good to excellent correlation with sTTE (r = 0.64-0.96, P < 0.001). The agreement in detection of various pathologies between PE TTE performed by the resident and sTTE examinations was moderate to very good, whereas it was good to excellent if PE TTE was performed by the experienced cardiologist. CONCLUSION The diagnostic accuracy of the PE in basic assessment of cardiac morphology and function as compared to standard echocardiography is moderate to very good for a cardiology resident and good to excellent for an experienced cardiologist. (Echocardiography 2012;29:1-6).
Collapse
|
13
|
Abstract
Heart failure is a major source of cardiovascular morbidity, including acute decompensations requiring hospitalization. Because most therapeutic interventions in acute heart failure target optimization of cardiac output and volume status, accurate assessment of these parameters at the point of care is critical to guide management. However, physician bedside assessments of left ventricular (LV) function and volume status have limited accuracy. Traditional echocardiographic platforms, while useful for assessing ventricular and valvular function and volume status, have limitations for bedside use or frequent serial evaluation. Handcarried cardiac ultrasound devices, with their substantially lower costs, portability, and ease of use, circumvent many of the limitations of traditional echocardiographic platforms. The diagnostic capabilities of handcarried devices provide the opportunity for ultrasound assessment of LV function and serial bedside evaluation of volume status in patients with acutely decompensated heart failure.
Collapse
|
14
|
Dalla Pozza R, Loeff M, Kozlik-Feldmann R, Netz H. Hand-carried ultrasound devices in pediatric cardiology: clinical experience with three different devices in 110 patients. J Am Soc Echocardiogr 2011; 23:1231-7. [PMID: 20888733 DOI: 10.1016/j.echo.2010.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aims of this study were to determine the usefulness of hand-carried ultrasound devices in pediatric cardiology and to compare the performance of three different hand-carried ultrasound devices in a pediatric cardiology outpatient clinic and intensive care unit. METHODS One hundred ten patients (49 male; mean age, 6.4 ± 5.2 years; range 0.1-38 years) with congenital heart defects or innocent heart murmurs were examined using Siemens Acuson P10, Siemens Acuson P50, and Philips CX 50 systems. The quality of images and the accuracy of B-mode measurements were compared with those obtained using a standard echocardiographic system (Philips iE33). RESULTS Fifty-nine patients were examined with the Siemens Acuson P10, 29 with the Siemens Acuson P50, and 22 with the Philips CX 50 system. There were no significant differences in B-mode measurements. The Acuson P10 system, however, showed significantly lower image quality, with 64.54% of all studies considered of excellent quality compared with 92.83% with the Acuson P50 and 95.52% with the CX 50 (P < .05) and a mean quality score (1 = fair, 5 = excellent) of 3.5 versus 4.57 with the Acuson P50 and 4.86 with the CX 50 (P < .05). This was attributed to the limited capacity for accurate diagnosis in children with body weights < 10 kg and complex heart defects. CONCLUSION Hand-carried ultrasound devices represent a valuable alternative to standard echocardiographic systems in pediatric cardiology. In particular, systems including all echocardiographic modalities offer unlimited versatility in outpatient and intensive care.
Collapse
Affiliation(s)
- Robert Dalla Pozza
- Department of Pediatric Cardiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
| | | | | | | |
Collapse
|
15
|
|