BackgroundAssessment of left ventricular (LV) function with echocardiography is mandatory in patients with suspected heart failure (HF).ObjectivesTo investigate if GPs were able to evaluate the LV function in patients at risk of developing or with established HF by using pocket-sized ultrasound (pUS).MethodsFeasibility study in general practice, seven GPs in three different Norwegian primary care centres participated. Ninety-two patients with reduced or at risk of developing reduced LV function were examined by their own GP using pUS. The scan (<5 minute) was done as part of a routine appointment. A cardiologist examined the patients <30 minutes afterwards with both a laptop scanner and pUS. Measurements of the septal mitral annular excursion (sMAE) were compared.ResultsIn 87% of the patients, the GPs were able to obtain a standard view and measure the sMAE. There was a non-significant mean difference in sMAE between GP pUS and cardiologist laptop scanner of −0.15 mm 95% confidence interval (−0.60 to 0.30) mm. A comparison of the pUS recordings and measurements of sMAE made by GP versus cardiologist revealed a non-significant mean difference with acceptable 95% limits of agreement (−0.26 ± 3.02 mm).ConclusionsWith tailored training, GPs were able to assess LV function with sMAE and pUS. pUS, as a supplement to the physical examination, may become an important tool in general practice.

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apical B-mode series can automatically be separated into cardiac cycles without using ECG.

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In this paper, we propose a multiscale nonlocal means-based despeckling method for medical ultrasound. The multiscale approach leads to large computational savings and improves despeckling results over single-scale iterative approaches. We present two variants of the method. The first, denoted multiscale nonlocal means (MNLM), yields uniform robust filtering of speckle both in structured and homogeneous regions. The second, denoted unnormalized MNLM (UMNLM), is more conservative in regions of structure assuring minimal disruption of salient image details. Due to the popularity of anisotropic diffusion-based methods in the despeckling literature, we review the connection between anisotropic diffusion and iterative variants of NLM. These iterative variants in turn relate to our multiscale variant. As part of our evaluation, we conduct a simulation study making use of ground truth phantoms generated from clinical B-mode ultrasound images. We evaluate our method against a set of popular methods from the despeckling literature on both fine and coarse speckle noise. In terms of computational efficiency, our method outperforms the other considered methods. Quantitatively on simulations and on a tissue-mimicking phantom, our method is found to be competitive with the state-of-the-art. On clinical B-mode images, our method is found to effectively smooth speckle while preserving low-contrast and highly localized salient image detail.

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