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Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
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[Diagnostic usefulness of pocket echography performed in hypertensive patients by a general practitioner]
Lidia Evangelista1, Enric Juncadella, Silvia Copetti
1Centro de Atención Primaria L'Hospitalet de Llobregat 1-centre, Servicio de Atención Primaria Delta de Llobregat, L'Hospitalet de Llobregat, Barcelona, España. levangelista@ambitcp.catsalut.net
Insights
Pocket echocardiography performed by general practitioners (GPs) in primary care offers a quick and effective method for early diagnosis of cardiac lesions in patients with arterial hypertension, improving treatment management.
Area of Science:
- Cardiology
- Primary Care Medicine
- Diagnostic Imaging
Background:
- Arterial hypertension poses significant risks for cardiac involvement.
- Conventional echocardiography, the gold standard for cardiac assessment, has limited availability in primary care settings.
- Early detection of cardiac complications in hypertensive patients is crucial for effective management.
Purpose of the Study:
- To evaluate the diagnostic utility of pocket echocardiography performed by general practitioners (GPs) in patients with arterial hypertension.
- To assess the feasibility and accuracy of pocket echocardiography in a primary care environment.
- To determine if this technique can aid in the early identification of cardiac lesions.
Main Methods:
- A cross-sectional study involving 393 patients with arterial hypertension.
- General practitioners (GPs) trained in pocket echocardiography conducted examinations.
- Expert cardiologist re-assessment and quantitative computer analysis were used for validation.
- Key cardiac structures and valve lesions were assessed.
Main Results:
- Pocket echocardiography examinations were completed in under 5 minutes with good-acceptable quality in 98% of cases.
- High concordance was observed between GP assessments and expert analysis for cardiac dimensions and several valve conditions.
- The GP diagnosed only 2.6% of significant cardiac lesions, indicating a need for further training or integration with specialist review.
Conclusions:
- Pocket echocardiography, when performed by GPs in primary care, serves as a valuable extension of clinical assessment for hypertensive patients.
- This technique facilitates early diagnosis of significant cardiac lesions, potentially leading to improved therapeutic strategies.
- Integration of pocket echocardiography into primary care can enhance the management of cardiovascular risks associated with hypertension.
Background And Objective:
Conventional echocardiography is the technique of choice for assessing cardiac involvement in arterial hypertension. Nevertheless, its availability in primary care is very limited. This study aimed to define the diagnostic usefulness of pocket echocardiography performed by a general practitioner (GP) in patients with arterial hypertension.
Patients And Method:
Cross-sectional study of a random sample of 393 patients with arterial hypertension. A GP appropriately trained in the technique performed an examination with a pocket echocardiograph and semiquantitatively assessed the different findings. The studies were blindly re-assessed by an expert cardiologist and analyzed quantitatively by computer software. Dimensions of the left ventricle, left atrium and ascending aorta were assessed, together with interventricular septum thickness and presence of valve lesions.
Results:
The study took less than 5min and the quality was good-acceptable in 98%. Analysis showed very good concordance (weighted kappa>0,83) in dimensions of the left ventricle, left atrium and ascending aorta, interventricular septum thickness, aortic regurgitation and aortic valve sclerosis, and good concordance (weighted kappa>0,71) in mitral regurgitation and mitral valve calcification. Only 6 (2.6%) of the significant lesions were diagnosed by the GP.
Conclusions:
Pocket echocardiography in primary care performed by a GP, as an extension of the clinical assessment of patients with arterial hypertension, provides an early diagnosis of significant cardiac lesions which may improve therapeutic management.
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