Abstract
Background: Rapid screening of cardiac patients with a hand‐held ultrasound imager (SonoHeart™ [SH]) could provide valuable clinical information.
Hypothesis: Whether the use of this device yields additional information to a carefully conducted physical examination and comparable findings to those of conventional two‐dimensional echocardiography (2‐D) during inpatient rounds is not well established and is the subject of this study.
Methods: In all, 100 consecutive telemetry patients underwent rapid screening with 2‐D and color Doppler SH during inpatient rounds. SonoHeart findings were compared with results from conventional 2‐D and physical examination conducted by an attending cardiologist.
Results: All patients had interpretable images. Mean scanning time with SH was 5.0 ± 1.2 min; 2‐D and SH findings were comparable. The parameters studied included chamber sizes, left ventricular (LV) systolic function, presence of LV hypertrophy (LVH), wall motion abnormalities (WMA), peri‐cardial effusion (PE), and valvular regurgitations. Mild to moderate valvular regurgitation and LV systolic dysfunction were reliably diagnosed by SH in a number of patients whose symptoms were unrelated to the abnormalities detected.
Conclusions: Rapid screening with SH provides accurate and valuable information that would otherwise be undetected during physical examination. Its introduction into clinical practice may redefine the initial approach to patients with cardiovascular disease.
Keywords: SonoHeart, screening, echocardiography, handheld, physical examination
Full Text
The Full Text of this article is available as a PDF (30.6 KB).
References
- 1. Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davidson TW, Davis JL, Douglas PS, Gillam LD: ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echo‐cardiography. Circulation 1997; 95: 1686–1744 [DOI] [PubMed] [Google Scholar]
- 2. Schwarz KQ, Meltzer RS: Experience rounding with a hand‐held two‐dimensional cardiac ultrasound device. Am J Cardiol 1988; 62: 157–159 [DOI] [PubMed] [Google Scholar]
- 3. Schiller NB: Hand‐held echocardiography: Revolution or hassle? J Am Coll Cardiol 2001; 37: 2023–2024 [DOI] [PubMed] [Google Scholar]
- 4. Roelandt JR: A personal ultrasound imager (ultrasound stethoscope). A revolution in the physical cardiac diagnosis Eur Heart J 2002; 23: 523–527 [DOI] [PubMed] [Google Scholar]
- 5. Spencer KT, Anderson AS, Bhargava A, Bales AC, Sorrentino M, Furlong K, Lang RM: Physician‐performed point of care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient. J Am Coll Cardiol 2001; 37: 2013–2018 [DOI] [PubMed] [Google Scholar]
- 6. Goodkin GM, Spevack DM, Tunick PA, Kronzon I: How useful is hand‐carried bedside echocardiography in critically ill patients? J Am Coll Cardiol 2001; 37: 2019–2022 [DOI] [PubMed] [Google Scholar]
- 7. Amico AF, Lichtenberg GS, Reisner SA, Stone CK, Schwartz RG, Meltzer RS: Superiority of visual versus computerized echocardiographic estimation of radionuclide ejection fraction. Am Heart J 1989; 118: 1259–1265 [DOI] [PubMed] [Google Scholar]
- 8. Sabia P, Abbott RD, Afrookteh A, Keller MW, Touchstone DA, Kaul S: Importance of two‐dimensional echocardiographic assessment of left ventricular systolic function in patients presenting to the emergency room with cardiac‐related symptoms. Circulation 1991; 84: 1615–1624 [DOI] [PubMed] [Google Scholar]
- 9. Sabia P, Afrookteh A, Touchstone DA, Keller MW, Esquivel L, Kaul S: Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two‐dimensional echocardiography. Circulation 1991; 84: I85–I92 [PubMed] [Google Scholar]
- 10. Reddy PS, Curtiss EI, O'Toole JD, Shaver JA: Cardiac tamponade: Hemo‐dynamic observations in man. Circulation 1978; 58: 265–272 [DOI] [PubMed] [Google Scholar]
- 11. Nishimura RA, Tajik AJ: Determination of left‐sided pressure gradients by utilizing Doppler aortic and mitral regurgitant signals Validation by simultaneous dual catheter and Doppler studies. J Am Coll Cardiol 1988; 11: 317–321 [DOI] [PubMed] [Google Scholar]
- 12. Nishimura RA, Tajik AJ: Quantitative hemodynamics by Doppler echocardiography: A noninvasive alternative to cardiac catheterization. Prog Cardiovasc Dis 1994; 36: 309–342 [DOI] [PubMed] [Google Scholar]
- 13. Nishimura RA, Appleton CP, Redfield MM, Ilstrup DM, Holmes DR Jr, Tajik AJ: Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: A simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol 1996; 28: 1226–1233 [DOI] [PubMed] [Google Scholar]
- 14. Nishimura RA, Tajik AJ: Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta Stone. J Am Coll Cardiol 1997; 30: 8–18 [DOI] [PubMed] [Google Scholar]
- 15. Oh JK, Appleton CP, Hatle LK, Nishimura RA, Seward JB, Tajik AJ: The noninvasive assessment of left ventricular diastolic function with two‐dimensional and Doppler echocardiography. J Am Soc Echocardiogr 1997; 10: 246–270 [DOI] [PubMed] [Google Scholar]
- 16. Ommen SR, Nishimura RA, Hurrell DG, Klarich KW: Assessment of right atrial pressure with 2‐dimensional and Doppler echocardiography: A simultaneous catheterization and echocardiographic study. Mayo Clin Proc 2000; 75: 24–29 [DOI] [PubMed] [Google Scholar]