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Accuracy and Efficacy of Hand-Held Echocardiography in Diagnosing Valve Disease: A Systematic Review

Examples of modern hand-held ultrasound devices. (A) GE Vscan dual probe ultrasound, (B) Philips Lumify ultrasound probe, (C) Siemens Acuson Freestyle, and (D) Fujifilm Sonosite Iviz. All images were obtained with permission from the different manufacturers.

In recent years, advances in technology have enabled hand-held echocardiography (HHE) to generate high-quality 2-dimensional and color Doppler images. As these devices become smaller, simpler, and more affordable, the question of whether HHE can augment or replace auscultation as the primary mode of cardiovascular diagnosis has become increasingly more relevant. If widely implemented, HHE has the potential for significant cost savings and better resource utilization. This review examines studies comparing the sensitivities of auscultation, HHE, and standard echocardiography in detecting various valvular lesions and discusses why current evidence supports the use of HHE to augment the physical examination, which can lead to more reliable and rapid bedside diagnoses, triage, and appropriate treatment of structural cardiac abnormalities.

Introduction

Many significant advances in technology have had a major effect on medical practice. One such advance is the miniaturization of ultrasound devices, which made hand-held echocardiography (HHE) available for use during bedside physical examination (Figure 1). Traditionally, physicians have used the stethoscope to assess cardiac function and to detect valvular abnormalities via auscultation. If abnormalities are recognized, the patient is referred for a standard echocardiogram, which prolongs the interval between the incident patient encounter, the subsequent diagnosis, and appropriate triage and treatment. In addition, although generally more junior physicians have less accurate auscultation skills, the accuracy of auscultation varies widely between examiners irrespective of their level of training.1 Several studies demonstrate that using HHE significantly improves the accuracy of diagnosing certain cardiac conditions with accuracy comparable to that of standard echocardiography, resulting in a more timely diagnosis.2, 3, 4, 5, 6 Recently, it has been proposed that insonation (performing bedside ultrasound) is the fifth component of the physical examination, after inspection, palpation, percussion, and auscultation.7 This systematic review of available studies to evaluate the accuracy of HHE for diagnosing common valvular abnormalities compared with physical examination and standard transthoracic echocardiography supports this concept.

Methods

The electronic database PubMed was systematically searched throughout April 2017 for the following Medical Subject Headings terms: ‘cardiac auscultation,’ ‘pocket echocardiograph,’ ‘pocket ultrasound,’ ‘hand-held echocardiography,’ ‘hand-held ultrasound,’ ‘point of care ultrasound,’ and ‘hand-carried ultrasound.’ We excluded studies conducted entirely on pediatric populations. We consolidated sensitivities of auscultation and HHE in diagnosing common valvular abnormalities from available studies. When not provided, sensitivities were calculated using given information on missed or correct diagnoses and a total number of cases using the following formula:

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-Felix Thomas, MD, Nir Flint, MD, Saman Setareh-Shenas, MD, MS, Florian Rader, MD, MSc, Sergio L. Kobal, MD, Robert J. Siegel, MD

This article originally appeared in the October issue of The American Journal of Medicine.

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