Pocket-sized Ultrasound versus Cardiac Auscultation in Diagnosing Cardiac Valve Pathologies: A Prospective Cohort Study

Abstract

Background: Pocket-sized ultrasound devices are used to perform focused ultrasound studies (POCUS). We compared valve malfunction diagnosis rate by cardiac auscultation to POCUS (insonation), both conducted by medical students.
 Methods: A prospective cohort study was conducted among patients with and without clinically relevant valve dysfunction. Recruitment to the study group was based on the presence of at least one valve pathology of at least moderate severity identified on recent echocardiography study that was required for clinical reasons. Three final-year medical students examined the patients. Each patient underwent auscultation and a POCUS using a pocket-sized ultrasound machine. Sensitivity was defined as the percentage of patients correctly identified as having a valve disorder. Specificity was defined as correct identification of the absence of valve pathology.
 Results: The study included 56 patients. In 18 (32%), no valve pathology was found. Nineteen patients (34%) had at least two valvular pathologies. Sixty valve lesions were present in the whole cohort. Students' sensitivity for detecting any valve lesion was 32% and 64% for auscultation and insonation; respectively, specificity was similar. 
 The sensitivity for diagnosing mitral regurgitation, mitral stenosis, and aortic regurgitation rose significantly by using POCUS compared to auscultation alone. When using POCUS, Students identified valve pathologies in 22 cases (39%) from the patients with at least two valve dysfunctions, and none when using auscultation.
 Conclusions: Final-year medical students' competency to detect valve dysfunction by performing cardiac auscultation is poor. Cardiac ultrasound-focused training significantly improved medical students' sensitivity for diagnosing a variety of valve pathologies.

The Effectiveness of Different Teaching Modalities for the Detection of Heart Murmurs in Undergraduate Medical Education: A Review

“…One pilot study conducted in 2021 used a prospective cohort of three, fourth-year medical students to test their ability to diagnose severe valvular dysfunction using POCUS and auscultation. Their training part of a one-week cardiology clerkship and consisted of 12 hours of handheld ultrasound operation completed in two-hour increments over the course of one month [ 16 ]. These sessions included anatomy lectures, bedside-guided lessons, and review of cases.…”

“…The authors concluded that in the three students tested, POCUS was significantly better for diagnosing a combination of valvular malfunctions in the same patient when compared to auscultation. These conclusions were based on diagnostic sensitivity and specificity, calculated via SPSS version 18 software [ 16 ]. Although the small sample size in this study poses a significant limitation, these preliminary results warrant further studies that expand on these conclusions.…”

Point-of-Care Ultrasound for the Diagnosis of Frequent Cardiovascular Diseases: A Review

“…Studies have shown that POCUS is superior to conventional auscultation for diagnosing valvular heart disease, even when performed by non-cardiologists. Examination with POCUS has been shown to improve the diagnostic accuracy of valvular heart disease by 50% to 80% in as little as 15 minutes after the start of the physical examination, even in final-year medical students increasing their percentage of valvular heart disease detection [ 45 ].…”

From Seeing to Knowing with Artificial Intelligence: A Scoping Review of Point-of-Care Ultrasound in Low-Resource Settings

“…For cardiac applications, POCUS devices have been used to evaluate aortic stenosis with anticipation of expanded utility to assess stenosis of other cardiac valves [66]. Direct training using a POCUS device allowed for increased diagnostic accuracy from younger medical students in comparison to traditional cardiac auscultation [67]. Additional case studies have also demonstrated the utility of POCUS devices not only for the cardiac system but also in the vasculature, whether it be for peripheral artery disease or aneurysms [68,69].…”