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Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the
K T Spencer1, A S Anderson, A Bhargava
1Department of Cardiology, University of Chicago, Illinois 60637, USA. kspencer@medicine.bsd.uchicago.edu
Insights
Point-of-care echocardiography significantly improves cardiovascular diagnosis compared to physical exams alone. This miniaturized tool aids cardiologists in detecting more heart conditions during patient encounters.
Area of Science:
- Cardiology
- Medical Diagnostics
- Point-of-Care Ultrasound
Background:
- Cardiovascular physical examination (PE) skills are declining.
- Traditional echocardiography is not typically performed at the point of care due to equipment limitations.
- Miniaturized echocardiography platforms offer potential solutions for in-office cardiac assessments.
Purpose of the Study:
- To compare the diagnostic accuracy of physical examinations (PEs) by cardiologists with point-of-care (POC) echocardiography.
- To evaluate the utility of a miniaturized echocardiographic platform in detecting cardiovascular pathology.
Main Methods:
- Thirty-six patients with cardiovascular disease underwent cardiovascular PEs by four board-certified cardiologists.
- Physicians then used a miniaturized echocardiographic platform for POC imaging of each patient.
- Results were compared against a gold standard complete echocardiographic study.
Main Results:
- Cardiovascular PEs missed 59% of overall cardiovascular findings and 43% of major findings.
- POC echocardiography with the prototype device missed 29% of overall pathology and 21% of major findings.
- POC echocardiography demonstrated reduced interphysician variability in diagnostic yield.
Conclusions:
- Point-of-care echocardiography significantly enhances the detection of cardiovascular pathology compared to traditional physical examinations.
- Routine use of miniaturized echocardiography by trained cardiovascular specialists can improve patient evaluation.
- This technology represents a valuable adjunct to the physical examination in cardiology.
Objectives:
The purpose of this study was to compare the results of physical examinations (PEs) performed by board-certified cardiologists with the results of point-of-care (POC) echocardiography in a group of patients with cardiovascular disease.
Background:
Although cardiovascular PE is crucial in the evaluation of patients with suspected heart disease, the skills required to diagnose abnormal cardiovascular findings have been declining. Echocardiography is a powerful noninvasive cardiovascular diagnostic tool; however, echocardiographic evaluation of patients is not performed at the time of patient encounter (POC echocardiography), beacuse current platforms are cumbersome and expensive for individual physician use. The development of miniaturized echocardiographic equipment has the potential to overcome some of these limitations.
Methods:
Thirty-six subjects had a complete cardiovascular examination by four board-certified cardiologists. The physicians subsequently imaged each patient using a miniaturized echocardiographic platform. The yield of PE and POC echocardiography were compared using a complete echocardiographic study as the gold standard, performed on an upper-end platform.
Results:
Cardiac examination failed to detect 59% of the overall cardiovascular findings. Physician-performed echocardiography with the prototype device missed 29% of the overall cardiovascular pathology. When considering only the major cardiovascular findings, the cardiologists' PEs still failed to correctly detect 43%. Point-of-care echocardiography reduced this to 21% without significant interphysician variation.
Conclusions:
Point-of-care echocardiography using a miniaturized echocardiographic platform substantially improved the detection of important cardiovascular pathology compared with PE. Use of this device by a cardiovascular specialist with training in echocardiography as a routine adjunct to PE appears to be useful.