A tale of two echoes: ultraportable versus standard echocardiography in patients with left ventricular dysfunction

Handheld echocardiography (HHE) is an emerging tool offering portability and convenience for cardiac imaging. However, its validity in hospitalised patients with left ventricular (LV) dysfunction is unclear.

To determine the concordance of key LV and right ventricular (RV) echocardiographic parameters obtained by HHE and standard echocardiography (SE) in hospitalised patients with LV dysfunction.

This prospective study evaluated hospitalised patients with an echocardiogram during admission demonstrating LV ejection fraction (LVEF) <50%. Key LV and right ventricular (RV) echocardiographic parameters were measured using both standard echocardiography (SE) and HHE. Concordance and differences between both imaging modalities were evaluated using Pearson correlation and paired Student t test, with significance defined as P < 0.05.

A total of 156 patients were included. No significant differences were observed between SE and HH for LV end-diastolic diameter (5.23 ± 0.87 vs. 5.28 ± 0.72 cm respectively, P = 0.348), LVEF (33.36 ± 9.2 vs. 33.17 ± 9.09, P = 0.521), LV outflow tract velocity time integral (15.83 ± 4.95 vs. 15.80 ± 5.05, P = 0.856) and inferior vena cava diameter (1.96 ± 0.48 vs. 1.92 ± 0.44, P = 0.122). Significant differences were noted for RV basal diameter (3.87 ± 0.63 cm vs. 3.76 ± 0.68 cm, P < 0.001) and tricuspid annular systolic excursion (1.76 ± 0.46 cm vs. 1.83 ± 0.47 cm, P = 0.025).

HHE demonstrates strong concordance with SE for LV parameters. Discrepancies were observed for RV parameters, although the clinical implications of these differences are unclear. These findings highlight the evolving role of HHE as a reliable and accessible tool for experienced users, particularly for monitoring hospitalised patients such as those with acute heart failure, where the use of serial SE may enhance clinical decision-making but is limited by logistical barriers.