Can Hospital Rounds With Pocket Echocardiography By Cardiologists Reduce Standard Transthoracic Echocardiography?

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Can Hospital Rounds With Pocket Echocardiography By Cardiologists Reduce Standard Transthoracic Echocardiography?

Am J Med. 2014 Mar 24;

Authors: Khan HA, Wineinger NE, Uddin PQ, Mehta HS, Rubenson DS, Topol EJ

BACKGROUND: Hospitalized patients are frequently referred for transthoracic echocardiograms (TTE). The availability of a pocket, mobile echocardiography (PME) device that can be incorporated on bedside rounds by cardiologists may be a useful and frugal alternative.
METHODS: This was a cross-sectional study designed to compare the accuracy of PME images with those acquired by TTE in a sample of hospitalized patients. Each patient referred for echocardiography underwent PME acquisition and interpretation by a senior cardiology fellow with level II training in echocardiography . Subsequently, a TTE was performed by skilled ultrasonographers and interpreted by experienced echocardiographers. Both groups were blinded to the results of the alternative imaging modality. Visualizability and accuracy for all key echocardiographic parameters (ejection fraction, wall motion abnormalities, left ventricular end diastolic dimension, inferior vena cava size, aortic and mitral valve pathology, and pericardial effusion) were determined and compared between imaging modalities.
RESULTS: 240 hospitalized patients underwent echocardiography with PME and TTE .The mean age was 71 ± 17 years. PME imaging time was 6.3 ± 1.5 min. Sensitivity of PME varied by parameter; was highest for aortic stenosis (97%) and lowest for aortic insufficiency (76%). Specificity also varied by parameter; was highest for mitral regurgitation (100%) and lowest for left ventricular ejection fraction (92%). Equivalence testing revealed the PME outcomes to be significantly equivalent to the TTE outcomes with no discernible differences in image quality between the PME and TTE (p=7.22x10(-7)). All outcomes remain significant after correcting for multiple testing using the false discovery rate (FDR).
CONCLUSION: The results from rapid bedside PME examinations performed by experienced cardiology fellows compared favorably with those from formal TTE studies. For hospitalized patients, this finding could shift the burden of performing and interpreting the echocardiogram to the examining physician and reduce the number and cost associated with formal echocardiography studies.

PMID: 24674919 [PubMed - as supplied by publisher]

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