Usefulness of hand-held echocardiography (VScan, GE) in bedside outpatients cardiology consultations in addition to physical examination: preliminary results from a multicentric Italian study

Abstract

Aims While patient history taking and physical examination remain the cornerstones of patient evaluation in clinical practice, there has been a decline in the accuracy of the latter. Hand-held echocardiographic devices have recently been introduced and could potentially improve the diagnostic accuracy of clinical examination. The aim of this study was to assess the usefulness of a new miniaturized echocardiographic system to perform bedside echocardiography in initial outpatient cardiology consultations, in addition to physical examination. Methods and results: One hundred fifty-one patients, referred for initial cardiology outpatient consultations, were studied in 6 Cardiologic Centres in Italy. Each patient was submitted to physical examination followed by VScan (GE Healthcare) assessment. Scanning time, the number of examinations with abnormal results after physical examination and the VScan, and the information obtained by physical examination alone and followed by the VScan (in terms of its importance in reaching a diagnosis, in the necessity of performing routine echocardiography, and in the decision to release the patient from the outpatient clinic) were assessed. The main consultation motives were: dyspnea (28%), chest pain (24%), arrhythmias (19%), shock (5%), syncope (5%), before surgery cardiologic evaluation (25%). The scanning time with the VScan was184±83 seconds. Its use after physical examination led to diagnosis in 106 patients (70%) and to an additional 25 patients (16%) being released from the outpatient clinic. After physical examination followed by VScan assessment, only 37 patients (24%) were sent to the echocardiography lab for further examination. The VScan modified the decision of whether to send a patient to the echocardiography lab, with referral determined by the VScan in 18 patients (11%) and no referral determined by the VScan in 58 patients (29%). The main diagnoses made with VScan were: increase of left and or right ventricular chambers, atrial dilation, left ventricular hypertrophic or dilative remodeling, previous myocardial infarction, low Left Ventricular ejection fraction, mitral or aortic valvular insufficiency or stenosis, pericardial effusion. Conclusions: The VScan utilization caused a negligible increase in the duration of consultations. It showed incremental value over physical examination, increasing the number of diagnoses, reducing the use of unnecessary routine echocardiography, increasing the number of adequate echocardiographic studies, and determining a large number of releases from the outpatient clinic.