Abstract
Miniaturization has evolved in the creation of a pocket-size imaging device which can be utilized as an ultrasound stethoscope. This study assessed the additional diagnostic power of pocket size device by both experts operators and trainees in comparison with physical examination and its appropriateness of use in comparison with standard echo machine in a non-cardiologic population.Three hundred four consecutive non cardiologic outpatients underwent a sequential assessment including physical examination, pocket size imaging device and standard Doppler-echo exam. Pocket size device was used by both expert operators and trainees (who received specific training before the beginning of the study). All the operators were requested to give only visual, qualitative insights on specific issues. All standard Doppler-echo exams were performed by expert operators.One hundred two pocket size device exams were performed by experts and two hundred two by trainees. The time duration of the pocket size device exam was 304 ± 117 sec. Diagnosis of cardiac abnormalities was made in 38.2% of cases by physical examination and in 69.7% of cases by physical examination + pocket size device (additional diagnostic power = 31.5%, p < 0.0001). The overall K between pocket size device and standard Doppler-echo was 0.67 in the pooled population (0.84 by experts and 0.58 by trainees). K was suboptimal for trainees in the eyeball evaluation of ejection fraction, left atrial dilation and right ventricular dilation. Overall sensitivity was 91% and specificity 76%. Sensitivity and specificity were lower in trainees than in experts.In conclusion, pocket size device showed a relevant additional diagnostic value in comparison with physical examination. Sensitivity and specificity were good in experts and suboptimal in trainees. Specificity was particularly influenced by the level of experience. Training programs are needed for pocket size device users.
Highlights
The dream of hand-held echocardiography first materialized during the 1970 s
The present study demonstrates that pocket-size imaging device (PSID) is useful in the detection of cardiac abnormalities and adds clinical information to physical exam (PE) in a population of patients referred for cardiac consultation, increasing the traditional consultation by only about 5 minutes
The simple visual assessment performed by PSID has a good concordance with standard Doppler echocardiographic examination and good diagnostic accuracy, which is higher in expert operators and lower in trainees
Summary
The dream of hand-held echocardiography first materialized during the 1970 s. An extreme miniaturization of echo machines has evolved with the creation of a pocket-size imaging device (PSID), small and light enough to fit in the hand. The cardiologic applications of PSID include the possibility of using it in coronary and emergency care units, for a first cardiac approach in ambulances, for screening programs in communities, and during cardiology consultations inside or outside the hospital The latter application highlights the possible use of this instrument as a completion of the traditional physical exam (PE), to add incremental information and, when needed, to appropriately refer patients to a standard Doppler echocardiographic examination. The diagnostic accuracy of PSID in identifying a limited number of parameters determinable by this new device in comparison with standard Doppler echocardiography and in relation to the level of ultrasound experience (comparison between experts operators and trainees)
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