Clinical Investigation
Echocardiography at the “Point of Care”
Diagnostic Accuracy of a Hand-Held Ultrasound Scanner in Routine Patients Referred for Echocardiography

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Background

The aim of this study was to investigate the imaging capabilities of recent hand-held ultrasound scanners.

Methods

Three hundred forty-nine patients were scanned with hand-held ultrasound (HAND) and high-end echocardiography (HIGH). Segmental endocardial border delineation was scored (2 = good, 1 = poor, 0 = invisible) to describe image quality. Assessments of left ventricular (LV) dimensions, regional and global LV function, and grades of valve disease were compared.

Results

The mean endocardial visibility grades were 1.6 ± 0.5 with HAND and 1.7 ± 0.4 with HIGH (P < .01). Regional wall motion was scored very similarly (κ = 0.73, P < .01). Ejection fraction assessment (bias = 1.8%, 1.96 × SD = 8.3%) and LV measurements (r = 0.99, P < .01; interventricular septum: bias = 0.91 mm, 1.96 × SD = 2.1 mm; LV end-diastolic diameter: bias = 0.5 mm, 1.96 × SD = 4.1 mm; LV posterior wall: bias = 0.61 mm, 1.96 × SD = 2.4 mm) showed negligible deviations. No pericardial effusion or valve stenosis was missed. Regurgitations missed by HAND were all graded “minimal” on HIGH. Regurgitations were mildly overestimated by HAND. Overall concordance for detection of regurgitations was very good (κ = 0.9, P < .01).

Conclusions

Handheld echocardiography was feasible and missed no relevant findings. Given the future implementation of spectral Doppler capabilities, this handheld scanner can safely be used in clinical routine.

Section snippets

Study Population and Echocardiographic Protocol

During a 5-week period, 349 unselected consecutive routine patients from the echocardiography lab at University Hospital Gasthuisberg (Leuven, Belgium) were scanned with a HAND scanner (Vscan; GE Vingmed Ultrasound AS, Horten, Norway; Figures 1A and 1B) and modern HIGH scanners, such as Vivid 7 or E9 (GE Vingmed Ultrasound AS) as the gold standard (using the M3S probe [GE Vingmed Ultrasound AS] at 1.5–4.0 MHz). Harmonic imaging was used in HIGH scanners by default. The examinations with HAND

Patient Population

We examined 349 consecutive routine patients (196 men). The mean age was 61.5 ± 15.0 years (range, 20.0–89.0 years). The patients had a mean body mass index of 25.8 ± 4.7 kg/m2 (range, 15.0–48.0 kg/m2). The LV EF ranged from 20% to 70% (mean, 55.6 ± 10.0%).

Use of the HAND Device

Operating the device was easy and intuitive. Basic functions were found quickly by trial and error. After reading an A4-size instruction card, all functions could be controlled without problems. Lifting the screen switches the device on and

Discussion

The introduction of HAND scanners has raised several questions. It is particularly interesting whether their image quality is sufficient for clinical decision making in daily clinical practice, considering that earlier studies reported drawbacks of older portable ultrasound devices in a cardiology outpatient clinic,6 in cardiology consultations in a hospital setting,7 in the screening of special patient subsets,8 or in small unselected populations of a tertiary cardiac center.8, 9, 10, 11 The

Conclusions

Echocardiography with handheld scanner was feasible in routine clinical practice. No clinically relevant findings were missed. Only spectral Doppler features are missing to make examinations complete and clinically valid. Apart from that, high-end scanning demonstrated advantages in image quality only in difficult-to-scan patients.

Given the future implementation of full standard echocardiographic functionality, this new class of device has the potential to be safely used by experienced

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