Handheld Echocardiography Measurements Concordance and Findings Agreement: An Exploratory Study

Abstract

The professional association has already developed guidelines on the appropriate use of handheld ultrasound devices, especially in an emergency setting. Handheld ultrasound devices are seen as the ‘stethoscope of the future’ to assist in physical examination. Our exploratory study evaluated whether the measurements of cardiovascular structures and the agreement in identifying aortic, mitral, and tricuspid valve pathology made by a resident with a handheld device (HH, Kosmos Torso-One) reach the results reported by an experienced examiner who used a high-end device (STD). Patients referred for cardiology examination in a single center from June to August 2022 were eligible for the study. Patients who agreed to participate underwent two heart ultrasound examinations scanned by the same two operators. A cardiology resident performed the first examination with a HH ultrasound device, and an experienced examiner performed the second examination with an STD device. Forty-three consecutive patients were eligible, and forty-two were included in the study. One obese patient was excluded because none of the examiners succeeded in performing the heart examination. The measurements obtained with HH were generally higher than those obtained with STD, with the highest mean difference of 0.4 mm, but without significant differences (all 95% confidence intervals of the differences contain the value of 0). For valvular disease, the lowest agreement was observed for mitral valve regurgitation (26/42, with a Kappa concordance coefficient of 0.5321), which was missed in almost half of the patients with mild regurgitation and underestimated in half of the patients with moderate mitral regurgitation. The measurements performed by the resident with the handheld Kosmos Torso-One device showed high concordance with those conducted by the experienced examiner with a larger high-end ultrasound device. The learning curve of the resident could explain the limited performance in identifying valvular pathologies between examiners.

Tele-Mentored Handheld Ultrasound System for General Practitioners: A Prospective, Descriptive Study in Remote and Rural Communities

“…Therefore, owing to the universal applicability of the tele-HHUS system, we believe that it could play a key role in providing basic healthcare services for the public, especially in resource-limited settings [ 15 ]. Many studies have shown that as a new portable diagnostic tool, HHUS has the same diagnostic efficiency as conventional ultrasound in the diagnosis of diseases of the heart, liver, lungs, and other organs [ 5 , 16 , 17 , 18 ]. HHUS has unlimited diagnostic potential, especially in acute and critically ill patients [ 19 , 20 ].…”

Efficacy of Handheld Ultrasound in Medical Education: A Comprehensive Systematic Review and Narrative Analysis

“…Regardless of the dimension, the US examination had some advantages compared to other imaging techniques, such as lack of radiation, low cost, reproducibility, and the possibility to examine patients at point-of-care [56]. The trainees preferred a conventional high-end ultrasound device when available [29], while generally, the measurements were concordant [23,45,57], and the difficulty of US learning and comfort levels were similar (p > 0.15) [45].…”

“…Ultrasound is a complex imaging modality, and image capturing and image interpretation require training [18,19], but there are still no standardized approaches regarding the content of training programs, their duration, or required trainer qualifications [20]. Considering that ultrasound examinations are user-dependent, the results reported in the scientific literature support the accuracy in measurements and lower image quality when compared to conventional US cardiac examinations [21][22][23].…”