Feasibility and reliability of point-of-care pocket-sized echocardiography

Abstract

AimsTo study the reliability and feasibility of point-of-care pocket-sized echocardiography (POCKET) at the bedside in patients admitted to a medical department at a non-university hospital.Methods and resultsOne hundred and eight patients were randomized to bedside POCKET examination shortly after admission and later high-end echocardiography (HIGH) in the echo-lab. The POCKET examinations were done by cardiologists on their ward rounds. Assessments of global and regional left ventricular (LV) function, right ventricular (RV) function, valvular function, left atrial (LA) size, the pericardium and pleura were done with respect to effusion and measurements of inferior vena cava (IVC) and abdominal aorta (AA) were performed. Correlations between POCKET and HIGH/appropriate radiological technique for LV function, AA size and presence of pericardial effusion were almost perfect, with r ≥ 0.92. Strong correlation (r ≥ 0.81) was shown for RV and valvular function, except for grading of aortic stenosis (r = 0.62). The correlations were substantial for IVC and LA dimensions. Median time used for bedside screening with POCKET was 4.2 min (range: 2.3–13.0). There was excellent feasibility for cardiac structures and pleura, which was assessed to satisfaction in ≥94% of patients. Lower feasibility (71–79%) was seen for the abdominal great vessels.ConclusionPoint-of-care semi-quantitative evaluation of cardiac anatomy and function showed high feasibility and correlation with the reference method for most indices. Pocket-sized echocardiographic examinations of ∼4 min length, performed at the bedside by experts, offers reliable assessment of cardiac structures, the pleural space and the large abdominal vessels.Clinical trial registration: ; unique ID: NCT01081210.

The Utility of Pocket-Sized Echocardiography to Assess Left Ventricular Systolic Function Prior to Permanent Pacemaker Implantation

“…The use of the PSE to visualize left ventricular wall motion and systolic function has been previously evaluated. Several studies have demonstrated that the PSE can obtain interpretable images in the vast majority (85-100%) of patients by inexperienced sonographers, in both the inpatient and outpatient settings [10][11][12]. A complete sTTE study takes approximately 20-25 minutes to acquire, with a standard echocardiography machine costing approximately four times that of a PSE machine [20].…”

“…Its size confers the advantage of portability, making PSE ideal for point-of-care evaluation, either at the bedside, or in the outpatient setting. Previous studies have examined the diagnostic accuracy of PSE, its potential clinical applications, and the training involved to maximize safety and effectiveness of its use [7][8][9][10][11]. Several studies have reported that PSE can qualitatively assess LVEF with good reliability, even when a sonographic trainee acquires and/or interprets images [12][13][14][15][16][17][18].…”

Bedside echocardiography in internal medicine: which key questions and answers for our decision-making?

“…Bedside cardiac ultrasound imaging allows a reliability and accuracy comparable to standard echocardiography to evaluate cardiac dimensions, significant systolic dysfunction and pericardial effusion 7,23,24 even when performed by non cardiologist 25,26 or medical residents 6,27 after a short training period and using miniaturized ultrasound devices.…”

“…24 Moreover despite the obvious limits of a gross evaluation, different studies showed that bedside echocardiography is definitely superior to physical examination in the detection of valvular regurgitation. 28,29 Heterogeneous results regarding the modality and duration of training for bedside echocardiography have been obtained through different teaching protocols applied to medical students or residents.…”

Pocket-Sized Ultrasound as an Aid to Physical Diagnosis for Internal Medicine Residents: A Randomized Trial

“…Pocket-sized ultrasound devices are powerful tools that have been found to perform similarly to traditional high-end systems when used by experienced clinicians. [5][6][7][8][9][10][11][12][13] Internal medicine residents desire ultrasound training, but self-reported competence is low. 14 Several studies have shown that after brief training, residents can become competent in performing and interpreting basic ultrasound examinations.…”