Handheld Echocardiography Measurements Concordance and Findings Agreement: An Exploratory Study
Mariam Haji-Hassan1, Bogdan Duțu2, Sorana D Bolboacă1
1Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania.
Insights
Handheld ultrasound devices show high measurement concordance with standard devices for cardiovascular structures. However, identifying mitral valve regurgitation requires further training for residents using handheld technology.
Area of Science:
- Cardiology
- Medical Imaging
- Point-of-Care Ultrasound
Background:
- Handheld ultrasound devices are emerging as essential tools in physical examinations, often termed the 'stethoscope of the future'.
- Professional guidelines exist for the appropriate use of these devices, particularly in emergency settings.
Purpose of the Study:
- To evaluate the accuracy of cardiovascular measurements obtained by a resident using a handheld ultrasound device (HH) compared to an experienced examiner using a standard device (STD).
- To assess the agreement in identifying aortic, mitral, and tricuspid valve pathology between HH and STD examinations.
Main Methods:
- An exploratory study involving 42 cardiology patients examined between June and August 2022.
- Two cardiac ultrasound examinations were performed on each patient: one by a cardiology resident using a HH (Kosmos Torso-One) device and another by an experienced examiner using an STD device.
- Measurements of cardiovascular structures and identification of valvular pathologies were compared between the two devices and operators.
Main Results:
- Measurements obtained with the HH device were generally higher than those from the STD device, but without statistically significant differences (95% CIs included 0).
- The lowest agreement between examiners was observed for mitral valve regurgitation (Kappa=0.5321), with the HH device missing mild cases and underestimating moderate cases in nearly half of the patients.
- Despite challenges with valvular pathology, measurements from the HH device showed high concordance with the STD device.
Conclusions:
- Cardiology residents using handheld ultrasound devices can achieve measurement accuracy comparable to experienced examiners with standard equipment.
- Further training and experience are needed for residents to improve the identification of specific valvular pathologies, such as mitral regurgitation, using handheld ultrasound technology.
- Handheld ultrasound devices show promise for cardiovascular examinations, but proficiency in diagnosing specific pathologies may depend on the operator's learning curve.
Abstract:
The professional association has already developed guidelines on the appropriate use of handheld ultrasound devices, especially in an emergency setting. Handheld ultrasound devices are seen as the 'stethoscope of the future' to assist in physical examination. Our exploratory study evaluated whether the measurements of cardiovascular structures and the agreement in identifying aortic, mitral, and tricuspid valve pathology made by a resident with a handheld device (HH, Kosmos Torso-One) reach the results reported by an experienced examiner who used a high-end device (STD). Patients referred for cardiology examination in a single center from June to August 2022 were eligible for the study. Patients who agreed to participate underwent two heart ultrasound examinations scanned by the same two operators. A cardiology resident performed the first examination with a HH ultrasound device, and an experienced examiner performed the second examination with an STD device. Forty-three consecutive patients were eligible, and forty-two were included in the study. One obese patient was excluded because none of the examiners succeeded in performing the heart examination. The measurements obtained with HH were generally higher than those obtained with STD, with the highest mean difference of 0.4 mm, but without significant differences (all 95% confidence intervals of the differences contain the value of 0). For valvular disease, the lowest agreement was observed for mitral valve regurgitation (26/42, with a Kappa concordance coefficient of 0.5321), which was missed in almost half of the patients with mild regurgitation and underestimated in half of the patients with moderate mitral regurgitation. The measurements performed by the resident with the handheld Kosmos Torso-One device showed high concordance with those conducted by the experienced examiner with a larger high-end ultrasound device. The learning curve of the resident could explain the limited performance in identifying valvular pathologies between examiners.
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