Diagnostic Accuracy and Cost-effectiveness of a Pocket-sized Transthoracic Echocardiographic Imaging Device

Overview

Journal Clin Cardiol

Specialty Cardiology & Vascular Diseases

Date 2013 Jul 30

PMID 23893844

Citations 15

Authors

Ryoko Kitada

Shota Fukuda

Hiroyuki Watanabe

Hiroki Oe

Yukio Abe

Minoru Yoshiyama

Jong-Min Song

Marta Sitges

Takahiro Shiota

Hiroshi Ito

Junichi Yoshikawa

Affiliations

Soon will be listed here.

Abstract

Background: The recently introduced pocket-sized portable transthoracic echocardiography (pTTE) is accurate for measurement of cardiac chamber size and function as well as for assessment of valvular regurgitation. This study aimed to compare the diagnostic accuracy of the pocket-sized pTTE with the standard TTE (sTTE) and assess its cost-effectiveness.

Hypothesis: The use of pocket-sized pTTE, as an initial screening tool, may be feasible, accurate and cost-effective in the diagnostic strategy of cardiac abnormalities.

Methods: The study subjects were 200 patients scheduled for sTTE and an electrocardiogram (ECG). Each patient underwent pTTE examination with the Vscan (GE Medical Systems, Milwaukee, WI) immediately after sTTE. The findings of pTTE and the ECG were compared with the results of sTTE. Cost-effectiveness was calculated.

Results: There was a strong agreement in the detection of abnormal findings between pTTE and sTTE (agreement = 90%), whereas the agreement between the ECG and sTTE was 65%. When pTTE or the ECG was used as an initial screening tool prior to sTTE, similar cost reduction was obtained (approximately 30%) by reducing the number of referrals for sTTE. However, the negative predictive value of a diagnostic strategy with pTTE (92%) was superior to that with an ECG (67%).

Conclusions: This study demonstrates that the pocket-sized pTTE provides accurate detection of cardiac structural and functional abnormalities beyond the ECG. In addition, the use of pTTE as an initial screening tool prior to sTTE is cost-effective, suggesting that the pocket-sized pTTE is poised to alter the current diagnostic strategy in clinical practice.

Citing Articles

Clinical validation of an artificial intelligence-assisted algorithm for automated quantification of left ventricular ejection fraction in real time by a novel handheld ultrasound device.

Papadopoulou S, Sachpekidis V, Kantartzi V, Styliadis I, Nihoyannopoulos P Eur Heart J Digit Health. 2023; 3(1):29-37.

PMID: 36713988 PMC: 9707920. DOI: 10.1093/ehjdh/ztac001.

The Scope of Clinical Applications of Handheld Echocardiography.

Kim E J Cardiovasc Imaging. 2022; 30(1):35-36.

PMID: 35086167 PMC: 8792711. DOI: 10.4250/jcvi.2021.0113.

Handheld Echocardiography in a Clinical Practice Scenario: Concordances Compared to Standard Echocardiographic Reports.

Gavazzoni Blume G, Lechinewski L, Vieira I, Clausell N, Bertinato G, Machado-Junior P J Cardiovasc Imaging. 2022; 30(1):25-34.

PMID: 35086166 PMC: 8792719. DOI: 10.4250/jcvi.2020.0241.

Community-based aortic stenosis detection: clinical and echocardiographic screening during influenza vaccination.

Steeds R, Potter A, Mangat N, Frohlich M, Deutsch C, Bramlage P Open Heart. 2021; 8(1).

PMID: 34021069 PMC: 8144056. DOI: 10.1136/openhrt-2021-001640.

Screening for aortic stenosis using physical examination and echocardiography.

Abe Y J Echocardiogr. 2021; 19(2):80-85.

PMID: 33415574 DOI: 10.1007/s12574-020-00511-8.

References

Greaves K, Jeetley P, Hickman M, Dwivedi G, Sabharwal N, Lim T . The use of hand-carried ultrasound in the hospital setting--a cost-effective analysis. J Am Soc Echocardiogr. 2005; 18(6):620-5. DOI: 10.1016/j.echo.2004.09.015. View

Cardim N, Fernandez Golfin C, Ferreira D, Aubele A, Toste J, Cobos M . Usefulness of a new miniaturized echocardiographic system in outpatient cardiology consultations as an extension of physical examination. J Am Soc Echocardiogr. 2010; 24(2):117-24. DOI: 10.1016/j.echo.2010.09.017. View

Andersen G, Haugen B, Graven T, Salvesen O, Mjolstad O, Dalen H . Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur J Echocardiogr. 2011; 12(9):665-70. PMC: 3171198. DOI: 10.1093/ejechocard/jer108. View

Tsutsui J, Maciel R, Costa J, Andrade J, Ramires J, Mathias Jr W . Hand-carried ultrasound performed at bedside in cardiology inpatient setting - a comparative study with comprehensive echocardiography. Cardiovasc Ultrasound. 2004; 2:24. PMC: 534795. DOI: 10.1186/1476-7120-2-24. View

Fukuda S, Shimada K, Kawasaki T, Fujimoto H, Maeda K, Inanami H . Pocket-sized transthoracic echocardiography device for the measurement of cardiac chamber size and function. Circ J. 2009; 73(6):1092-6. DOI: 10.1253/circj.cj-08-1076. View

Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P . Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of.... J Am Soc Echocardiogr. 2005; 18(12):1440-63. DOI: 10.1016/j.echo.2005.10.005. View

Spencer K, Anderson A, Bhargava A, Bales A, Sorrentino M, Furlong K . Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient. J Am Coll Cardiol. 2001; 37(8):2013-8. DOI: 10.1016/s0735-1097(01)01288-8. View

Than M, Cullen L, Reid C, Lim S, Aldous S, Ardagh M . A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Lancet. 2011; 377(9771):1077-84. DOI: 10.1016/S0140-6736(11)60310-3. View

Lafitte S, Alimazighi N, Reant P, Dijos M, Zaroui A, Mignot A . Validation of the smallest pocket echoscopic device's diagnostic capabilities in heart investigation. Ultrasound Med Biol. 2011; 37(5):798-804. DOI: 10.1016/j.ultrasmedbio.2011.02.010. View

10.

Galasko G, Barnes S, Collinson P, Lahiri A, Senior R . What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination?. Eur Heart J. 2005; 27(2):193-200. DOI: 10.1093/eurheartj/ehi559. View

11.

SOKOLOW M, LYON T . The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949; 37(2):161-86. DOI: 10.1016/0002-8703(49)90562-1. View

12.

Tofield A . The use of pocket size imaging devices: a position statement by the European Association of Echocardiography. Eur Heart J. 2011; 32(4):385-6. DOI: 10.1093/eurheartj/ehr001. View

13.

Lim T, Dwivedi G, Hayat S, Collinson P, Senior R . Cost effectiveness of the B type natriuretic peptide, electrocardiography, and portable echocardiography for the assessment of patients from the community with suspected heart failure. Echocardiography. 2007; 24(3):228-36. DOI: 10.1111/j.1540-8175.2007.00398.x. View

14.

Zoghbi W, Enriquez-Sarano M, Foster E, Grayburn P, Kraft C, Levine R . Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003; 16(7):777-802. DOI: 10.1016/S0894-7317(03)00335-3. View

15.

Mjolstad O, Dalen H, Graven T, Kleinau J, Salvesen O, Haugen B . Routinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department. Eur J Intern Med. 2012; 23(2):185-91. DOI: 10.1016/j.ejim.2011.10.009. View

16.

Badano L, Nucifora G, Stacul S, Gianfagna P, Pericoli M, Del Mestre L . Improved workflow, sonographer productivity, and cost-effectiveness of echocardiographic service for inpatients by using miniaturized systems. Eur J Echocardiogr. 2009; 10(4):537-42. DOI: 10.1093/ejechocard/jen341. View

17.

Kono Y, Fukuda S, Shimada K, Oe H, Maeda K, Kawasaki T . Pocket-sized echo for evaluation of mitral and tricuspid regurgitation. JACC Cardiovasc Imaging. 2011; 4(8):921. DOI: 10.1016/j.jcmg.2011.02.022. View

18.

Vourvouri E, Poldermans D, Schinkel A, Koroleva L, Sozzi F, Parharidis G . Left ventricular hypertrophy screening using a hand-held ultrasound device. Eur Heart J. 2002; 23(19):1516-21. DOI: 10.1053/euhj.2002.3162. View

19.

Trambaiolo P, Papetti F, Posteraro A, Amici E, Piccoli M, Cerquetani E . A hand-carried cardiac ultrasound device in the outpatient cardiology clinic reduces the need for standard echocardiography. Heart. 2006; 93(4):470-5. PMC: 1861486. DOI: 10.1136/hrt.2006.094201. View

20.

Nagueh S, Appleton C, Gillebert T, Marino P, Oh J, Smiseth O . Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009; 22(2):107-33. DOI: 10.1016/j.echo.2008.11.023. View