Hand-held echocardiography in the setting of pre-operative cardiac evaluation of patients undergoing non-cardiac surgery: results from a randomized pilot study

Abstract

Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96%; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P < 0.001). HHE resulted in a consistent save of waiting time because it was performed the same day of clinical evaluation whereas patients waited 10.1 ± 6.1 days for a standard echocardiography (P < 0.001). This study suggests the potential role of HHE for pre-operative evaluation of selected patients undergoing non-cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography.

Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery

“…By comparing the use of the ultraportable cardiac US (Opti-Go Philips) with the conventional echocardiography (Philips iE33), the investigators found the same rate of diagnostic conclusiveness between the techniques, although the former is faster and promotes a less waiting time, which optimizes the preoperative evaluation. 18 In this study, 211 patients without suspicion of heart diseases and previously approved for surgeries were studied, which may explain the higher percentages of tests without significant changes in our sample (60.7% versus 12.8%). In the Italian study, 18 patients were randomized to one of two techniques, and 50 patients underwent the ultraportable cardiac US, whereas in our study, all patients underwent this technique.…”

“…18 In this study, 211 patients without suspicion of heart diseases and previously approved for surgeries were studied, which may explain the higher percentages of tests without significant changes in our sample (60.7% versus 12.8%). In the Italian study, 18 patients were randomized to one of two techniques, and 50 patients underwent the ultraportable cardiac US, whereas in our study, all patients underwent this technique.…”

“…Cavallari and colleagues published a study on the use of ultraportable cardiac US in patients with indication of noncardiac surgery. 18 The authors randomly assessed 100 patients with known heart disease or important cardiovascular complaints referred to echocardiography by a cardiologist. By comparing the use of the ultraportable cardiac US (Opti-Go Philips) with the conventional echocardiography (Philips iE33), the investigators found the same rate of diagnostic conclusiveness between the techniques, although the former is faster and promotes a less waiting time, which optimizes the preoperative evaluation.…”

Cardiovascular imaging 2015 in the International Journal of Cardiovascular Imaging

“…Hand-held echocardiography could be considered an alternative to standard echocardiography in the pre-operative evaluation of patients undergoing non-cardiac surgery. Cavalli et al [20] compared standard echo to bedside evaluation with a pocket-size imaging device in 100 patients scheduled for non-cardiac surgery. H and-held echo pro-patients with acute Mi.…”

Association of Echocardiography Before Major Elective Non-Cardiac Surgery With Improved Postoperative Outcomes ― Possible Implications for Patient Care ―

“…It also provides information on ventricular dysfunction, valvular disease, and regional wall motion abnormality. [6][7][8] However, clinical evidence regarding the utility of preoperative echocardiography in non-cardiac surgery is limited. There is no recommendation for the use of echocardiography, except for high-risk vascular procedures in patients with reduced functional capacity.…”