Abstract
Background:Handheld echocardiography is being proposed as the fifth pillar of bedside physical cardiovascular examination (PE) and is referred to as insonation. Although there is emerging consensus that insonation is superior to PE for diagnosis of various cardiac conditions, superiority has not been consistently demonstrated for various valvular heart disease (VHD) lesions. The objective of this review is to systematically review the accuracy of insonation and auscultation in published literature for detection of common VHD.Methods:An extensive literature search across three commonly used public databases allowed comparison of diagnostic characteristics of insonation and auscultation for common VHD including aortic stenosis, mitral regurgitation, aortic regurgitation, tricuspid regurgitation. Sensitivity, specificity, and accuracy of insonation and auscultation for the detection of these VHD lesions were extracted for further analysis. The quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.Results:Eight hundred eighty studies were screened, and seven observational studies were selected for full analysis. Due to heterogeneity of data, this study was not amenable to meta-analysis. Insonation was superior to auscultation for the detection of all regurgitant lesions, but there was no significant difference in diagnostic ability of the two strategies for detection of aortic stenosis.Conclusions:Compared to auscultation, insonation, in its currently available form, is a superior diagnostic tool for regurgitant lesions. However, insonation fails to improve upon auscultation for recognition of aortic stenosis. This limitation is likely due to absence of spectral Doppler and inability of HE to assess transvalvular velocity and gradient.
Highlights
Physical examination has remained the mainstay for bedside diagnosis of cardiovascular disease for centuries
The purpose of this review was to rigorously evaluate and summarize, using GRADE methodology, the available evidence underpinning the utility of handheld echocardiography (HE) in assessment of valvular heart disease (VHD), focusing on the comparison of diagnostic power of HE compared to physical examination
Insonation has been proposed as the fifth pillar of bedside physical cardiovascular examination
Summary
Physical examination has remained the mainstay for bedside diagnosis of cardiovascular disease for centuries. Physical examination is an indispensable component of patient bedside assessment, incorporation of new imaging technology such as portable cardiac ultrasound has allowed for enhanced point-of-care clinical diagnosis. Handheld echocardiography is being proposed as the fifth pillar of bedside physical cardiovascular examination (PE) and is referred to as insonation. There is emerging consensus that insonation is superior to PE for diagnosis of various cardiac conditions, superiority has not been consistently demonstrated for various valvular heart disease (VHD) lesions. Sensitivity, specificity, and accuracy of insonation and auscultation for the detection of these VHD lesions were extracted for further analysis. Insonation fails to improve upon auscultation for recognition of aortic stenosis This limitation is likely due to absence of spectral Doppler and inability of HE to assess transvalvular velocity and gradient
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