echnological advances in electronic miniaturization have resulted in the creation of small, portable transthoracic echocardiographic (pTTE) devices. The major advantage of a portable device is being able to provide immediate information both within and, for the first time, outside the hospital setting. Previous studies have reported that pTTE is superior to physical examination, and comparable with complete standard TTE (sTTE) as a diagnostic tool in clinical practice. 1-3 Physical examination is recognized as an initial screening method, but the skill set required to perform physical examinations has unfortunately deteriorated over the past 2 decades as medical technology has advanced. 4-6 Therefore, visualizing the heart as well as being able to calculate limited quantitative measurements of the cardiac chambers and their function, may result in improved patient care and/or understanding.Compared with a stethoscope, previous portable devices were too large and heavy (≈2.5 kg) for physicians to carry while making rounds. A pocket-sized imaging device has better portability and agility, enhancing the use of pTTE. 7 We investigated the feasibility and accuracy of pTTE for assessing cardiac chamber size and function. Methods Study PopulationThe study group consisted of 125 unselected patients (70 males, mean age 70±13 years) who were scheduled for sTTE to evaluate left ventricular (LV) function: 65 patients with coronary artery disease (24 with a history of myo- (Received November 18, 2008; revised manuscript received January 27, 2009; accepted January 28, 2009; released online April 16, 2009

Background:In the absence of obstructive coronary narrowing, impaired coronary flow reserve (CFR) represents coronary microvascular dysfunction. Transthoracic Doppler echocardiography (TTDE) allows non-invasive measurement of CFR in the left anterior descending (LAD) artery. This study aimed to assess the prognostic value of TTDEderived CFR (as a marker of microvascular function) in predicting long-term cardiovascular events, acute coronary syndrome (ACS) events, and the development of heart failure (HF). Methods and Results:This study consisted of 272 patients with coronary artery disease not involving obstructive narrowing (≥50%) in the LAD. Patients underwent TTDE examination for CFR measurement in the LAD. During the follow-up period of 4.0±1.9 years, 32 patients (12%) had cardiovascular events. Cox proportional hazard analysis identified lower CFR as an independent risk factor of cardiovascular events (P<0.001), ACS events (P=0.008), and HF development (P=0.003). A CFR less than 2.4 was the best cut-off value for predicting all events (area under the curve=0.82). CFR excellently predicted the development of HF (area under the curve=0.95), but not ACS events (area under the curve=0.67). Conclusions:This TTDE study demonstrated that CFR was a significant and independent determinant of long-term cardiovascular events, ACS events and HF in patients with coronary artery disease. A CFR greater than 2.0 was not suitable to predict a favorable long-term outcome, even in the absence of obstructive coronary narrowing. (Circ J 2012; 76: 1958 - 1964

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Advances in electronic miniaturization and digital techniques have resulted in the advent of portable transthoracic echocardiography (pTTE) imaging devices in the area of echocardiography. A pocket-sized pTTE imaging device that has color Doppler imaging capability has been recently introduced into clinical practice. This study aimed to examine the feasibility and accuracy of the pocket-sized pTTE in the assessment of the severity of mitral regurgitation (MR) and tricuspid regurgitation (TR).One hundred and eighty-six consecutive patients (ages 66 Ϯ 19 years; 107 male) underwent standard transthoracic echocardiography (sTTE) and pTTE. Initially, pTTE was performed by a well-trained sonographer for 121 patients. For the later 65 patients, pTTE was examined by a less experienced sonographer who had 6 months of experience in echocardiography, with the number of TTE examinations compatible with American Society of Echocardiography training level 1 (1). These sonographers were blinded to sTTE results and all clinical information.This study was approved by the ethics committees of Osaka Ekisaikai Hospital and Okayama University. Pocket-sized pTTE was performed using the Vscan (GE Medical Systems, Milwaukee, Wisconsin). The apical 4-chamber view by the color Doppler images was obtained with sTTE and pTTE, respectively. The ratio of regurgitant jet area to atrial area was then calculated for MR (%MR) and TR (%TR). The severity of regurgitation was graded as mild if it occupied Ͻ20%, moderate if between 20% and 34%, and severe if Ͼ34% in TTE examination.Linear regression analysis was used for the correlation of variables of interest. Differences were considered significant at p Ͻ 0.05. Differences between sTTE and pTTE results were also compared with the mean value obtained by sTTE and pTTE using the Bland-Altman method, with the limits of agreement defined as Ϯ 2 SD of the difference between the 2 methods.Echocardiographic measurements were completed for sTTE and pTTE in all patients (feasibility 100%). In the examination by the well-trained sonographer, there were excellent correlations in MR jet area, left atrial area, %MR, TR jet area, right atrial area, and %TR between sTTE and pTTE (r ϭ 0.89 to 0.96, p Ͻ 0.001). Also, there were small systematic differences with close limits of agreement between sTTE and pTTE measurements, respectively: Ϫ0.2 cm 2 and 1.5 cm 2 for MR jet area; Ϫ0.4 cm 2 and 4.6 cm 2 for left atrial area; Ϫ0.5 cm 2 and 5.6 cm 2 for %MR; Ϫ0.2 cm 2 and 2.3 cm 2 for TR jet area; 0.0 cm 2 and 4.2 cm 2 for right atrial area; and Ϫ1.2 cm 2 and 8.9 cm 2 for %TR. The sensitivity and specificity of pTTE for detecting more than moderate MR were both 96%. The sensitivity and specificity of pTTE for detecting more than moderate TR were 94% and 96%, respectively. In patients with more than moderate regurgitation, the evaluation of the etiology of MR and TR by pTTE was the same as for those with sTTE.In the examination with the less experienced sonographer, the correlations between sTTE and pTTE were slightly reduc...