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Updated: Oct 25, 2025
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Diagnostic accuracy of handheld cardiac ultrasound device for assessment of left ventricular structure and function:
Sam Jenkins1, Samer Alabed1, Andrew Swift2
1Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK.
Insights
Handheld ultrasound devices (HUD) accurately diagnose left ventricular (LV) dysfunction, especially with experienced operators. HUD can serve as a valuable tool to aid clinical decisions in secondary care.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Technology
Background:
- Left ventricular (LV) dysfunction assessment is crucial for patient management.
- Transthoracic echocardiography (TTE) is the standard for evaluating LV function.
- Handheld ultrasound devices (HUD) offer a portable alternative for cardiac assessment.
Purpose of the Study:
- To evaluate the diagnostic ability of HUD in detecting LV dysfunction.
- To compare the accuracy of HUD with TTE.
- To assess the impact of operator experience on HUD diagnostic performance.
Main Methods:
- A meta-analysis of diagnostic studies was conducted.
- MEDLINE and EMBASE databases were searched for relevant studies.
- Pooled sensitivities, specificities, and summary receiver operating characteristic curves were analyzed.
Main Results:
- Experienced operators demonstrated high sensitivity and specificity in detecting reduced LV ejection fraction (LVEF), wall motion abnormality (WMA), LV dilatation, and LV hypertrophy.
- Significant differences in diagnostic accuracy were observed between experienced and inexperienced users for LV dilatation, LVEF, and WMA.
- HUD proved to be a powerful modality for predicting LV size and function, with experienced operators achieving superior results.
Conclusions:
- HUD is a powerful tool for predicting LV size and function, comparable to TTE when used by experienced operators.
- Operator experience significantly influences diagnostic accuracy.
- HUD can be considered an auxiliary tool to physical examination, aiding clinical decision-making in secondary care.
Objective:
Handheld ultrasound devices (HUD) has diagnostic value in the assessment of patients with suspected left ventricular (LV) dysfunction. This meta-analysis evaluates the diagnostic ability of HUD compared with transthoracic echocardiography (TTE) and assesses the importance of operator experience.
Methods:
MEDLINE and EMBASE databases were searched in October 2020. Diagnostic studies using HUD and TTE imaging to determine LV dysfunction were included. Pooled sensitivities and specificities, and summary receiver operating characteristic curves were used to determine the diagnostic ability of HUD and evaluate the impact of operator experience on test accuracy.
Results:
Thirty-three studies with 6062 participants were included in the meta-analysis. Experienced operators could predict reduced LV ejection fraction (LVEF), wall motion abnormality (WMA), LV dilatation and LV hypertrophy with pooled sensitivities of 88%, 85%, 89% and 85%, respectively, and pooled specificities of 96%, 95%, 98% and 91%, respectively. Non-experienced operators are able to detect cardiac abnormalities with reasonable sensitivity and specificity. There was a significant difference in the diagnostic accuracy between experienced and inexperienced users in LV dilatation, LVEF (moderate/severe) and WMA. The diagnostic OR for LVEF (moderate/severe), LV dilatation and WMA in an experienced hand was 276 (95% CI 58 to 1320), 225 (95% CI 87 to 578) and 90 (95% CI 31 to 265), respectively, compared with 41 (95% CI 18 to 94), 45 (95% CI 16 to 123) and 28 (95% CI 20 to 41), respectively, for inexperienced users.
Conclusion:
This meta-analysis is the first to establish HUD as a powerful modality for predicting LV size and function. Experienced operators are able to accurately diagnose cardiac disease using HUD. A cautious, supervised approach should be implemented when imaging is performed by inexperienced users. This study provides a strong rationale for considering HUD as an auxiliary tool to physical examination in secondary care, to aid clinical decision making when considering referral for TTE.
Trial Registration Number:
CRD42020182429.
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