Clinical utility and diagnostic accuracy of a novel handheld ultrasound device for cardiac evaluation in non-cardiology settings

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Abstract Background During consultation rounds in non-cardiology departments the cardiologist is confronted with clinical questions which often require further evaluation with echocardiography. Transporting a cart-based standard echocardiography (SE) machine to this end is unpractical, and referral to the echocardiography laboratory is routine practice in most cases. Recently, technological advances have enabled the development of handheld ultrasound devices (HUDs) that are equipped with M-mode, color and spectral Doppler capabilities, on top of improved 2D image quality. The use of such novel HUDs in non-cardiology settings may reduce the referrals for SE exam and expedite clinical workflow for those patients, but data on clinical safety and accuracy of such approach are lacking. Purpose The aim of this study was to evaluate the clinical utility and diagnostic accuracy of a novel HUD for cardiac evaluation during consultation rounds in non-cardiology settings. Methods The study comprised 102 consecutive patients (age 66±17 years, 52% male) from non-cardiology departments of a tertiary hospital who were referred for an echocardiogram after cardiology consultation. All patients were scanned with the HUD by the consulting cardiologist and subsequently underwent an exam with a SE machine by an echocardiographer. For each patient the consulting cardiologist noted whether the findings of the HUD were adequate for final diagnosis, as well as the image quality and the time required to perform the focused cardiac exam using the HUD. The following parameters were assessed: 1) LV size and function, 2) RV size and function, 3) significant (more than moderate) valvular heart disease (VHD), 4) pericardial effusion, and 5) inferior vena cava (IVC) size and collapse. Results In 86 (84%) patients, it was possible to successfully answer the clinical question by the HUD examination alone. In 71 (70%) patients no further examination with SE was deemed as necessary. The HUD image quality was good in 24 patients, moderate in 59 patients, bad in 18 patients, and non-diagnostic in 1 patient. The mean time required per patient for the focused cardiac exam with the HUD was 5.7±2.2 minutes. The prevalence of abnormal echo findings in the study population is presented in Table 1. There was excellent agreement for the detection of abnormal LV size and function (k=0.936), abnormal RV size and function (k=0.928), pericardial effusion (k=0.936), and abnormal IVC size and collapse (k=0.960). There was good agreement for significant VHD (k=0.735). In 5 cases the clinical question was not answered even after the SE examination and further cardiac imaging was needed (3 transesophageal echo, 1 contrast echo, 1 CT pulmonary angiography). Conclusion A novel HUD can provide accurate detection of cardiac abnormalities during consultation rounds in non-cardiology settings. Its use in clinical practice may be a valuable alternative to SE for most patients in non-cardiology departments.