Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient

Spencer, Kirk T.; Anderson, Allen S.; Bhargava, Ajay; Bales, Amy C.; Sorrentino, Matthew J.; Furlong, Kathy T.; Lang, Roberto M.

doi:10.1016/s0735-1097(01)01288-8

Cited by 178 publications

(112 citation statements)

References 14 publications

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“…However, barriers to the widespread implementation of an echocardiographic method in outpatient dialysis clinics include the cost and availability of conventional ultrasound machines, as well as the specialized training that is necessary for operation of these platforms. The introduction of hand-carried cardiac ultrasound (HCU) devices, which are relatively inexpensive and portable, has allowed bedside cardiac evaluation at the time of physician encounter in numerous settings (25)(26)(27). Recent studies have demonstrated acceptable accuracy when limited HCU examinations were performed by noncardiologists (28,29).…”

mentioning

confidence: 99%

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

Brennan

Ronan

Goonewardena

et al. 2006

Clinical Journal of the American Society of Nephrology

189

133

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Accurate intravascular volume assessment is critical in the treatment of patients who receive chronic hemodialysis (HD) therapy. Clinically assessed dry weight is a poor surrogate of intravascular volume; however, ultrasound assessment of the inferior vena cava (IVC) is an effective tool for volume management. This study sought to determine the feasibility of using operators with limited ultrasound experience to assess IVC dimensions using hand-carried ultrasounds (HCU) in the outpatient clinical setting. The IVC was assessed in 89 consecutive patients at two outpatient clinics before and after HD. Intradialytic IVC was recorded during episodes of hypotension, chest pain, or cramping. High-quality IVC images were obtained in 79 of 89 patients. Despite that 89% of patients presented at or above dry weight, 39% of these patients were hypovolemic by HCU. Of the 75% of patients who left HD at or below goal weight, 10% were still hypervolemic by HCU standards. Hypovolemic patients had more episodes of chest pain and cramping (33 versus 14%, P ‫؍‬ 0.06) and more episodes of hypotension (22 versus 3%, P ‫؍‬ 0.02). The clinic with a higher prevalence of predialysis hypovolemia had significantly more intradialytic adverse events (58 versus 27%; P ‫؍‬ 0.01). HCU measurement of the IVC is a feasible option for rapid assessment of intravascular volume status in an outpatient dialysis setting by operators with limited formal training in echocardiography. There is a poor relationship between dry weight goals and IVC collapsibility. Practice variation in the maintenance of volume status is correlated with significant differences in intradialysis adverse events.

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mentioning

confidence: 99%

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

Brennan

Ronan

Goonewardena

et al. 2006

Clinical Journal of the American Society of Nephrology

189

133

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“…Several previous studies reported that HCU showed good concordance of diagnostic capability with SED in terms of assessing LVEF and LV dimension measurement and detecting pericardial effusion and valve disease (4)(5)(6)(7)(8)(9) . Also, they are being placed in emergency or critical care settings to assist in the evaluation of hemodynamically compromised patients (10)(11)(12) .…”

Section: Discussionmentioning

confidence: 86%

Comparison of Ultraportable Cardiac Echocardiography with Physical Examination for Diagnosis and Management during Cardiac Consultation Rounds

Astarcıoğlu¹,

Sen²,

Kılıt³

et al. 2016

Kosuyolu Heart Journal

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Introduction: The purpose of this study was to compare the results of physical examinations (PEs) performed by a cardiologist with the results of point-of-care echocardiography for the diagnosis and management of patients during cardiac consultation rounds. Patients and Methods:In all, 265 hospitalized consecutive patients from non-cardiac units (age, 62 ± 11; male, 56%) were included after complete cardiovascular (CV) examination by a consulting cardiologist. After the PE, the consulting cardiologist imaged each patient using a hand-carried cardiac ultrasound (HCU). All patients subsequently underwent a study with a standard echocardiographic device (SED) as the gold standard, performed on an upper-end platform. Defi nitive diagnosis, management change, and modifying diagnostic workup were also assessed.Results: There were 196 CV fi ndings detected with an SED in this patient population. Of these, PE failed to detect 41% of the overall CV fi ndings and HCU missed 23% of the overall CV pathology. Overall, HCU had an effect on patient treatment decisions in 149 patients (56%); 42% had a change in medical therapy and 21% had a change in their diagnostic workup (most with changes in both). Conclusion:HCU echocardiographic assessment during consultation rounds improved the detection of signifi cant CV pathology. Also, a direct assessment of cardiac function and anatomy at the bedside by an experienced cardiologist with HCU as a routine adjunct to PE results in an important change in clinical management and diagnostic workup during consultation.Key Words: Hand-carried cardiac ultrasound; point-of-care screening Kardiyak Konsültasyonlar Esnasında Tanı ve Tedavide Taşınabilir Ekokardiyografi Cihazları ile Birlikte Fizik Muayenenin Karşılaştırılması ÖZETGiriş: Bu çalışmanın amacı, kardiyak konsültasyon esnasında tanı ve tedavi üzerinde ekokardiyografi sonuç-ları ile kardiyolog tarafından gerçekleştirilen fi zik muayene sonuçlarını karşılaştırmaktır.

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“…With the currently available hand-held echocardiography equipment a trained physician is able to detect cardiac pathology with high sensitivity. 29 The relatively high number of patients with diastolic dysfunction could be explained by the high percentage of patients with hypertension. The prevalence of hypertension was comparable with the prevalence of hypertension in non-Hispanic white men in the NHAHES survey.…”

Section: Discussionmentioning

confidence: 99%

The Dutch experience of open access echocardiography

Cl¹,

Lh²,

Lenderink³

et al. 2007

NHJL

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Keywords: open access echocardiography, rapid access echocardiography, echocardiography, heart failure, valvular heart disease, hypertension D ue to the ageing population, the general practitioner will see more patients with symptoms of dyspnoea. 1,2 For the general practitioner, with his limited diagnostic facilities, it is frequently very difficult to distinguish between dyspnoea due to cardiac and non-cardiac causes. 3 Dyspnoea can be due to systolic or diastolic dysfunction, but can also be caused by pericardial disease, hypertension and non-cardiac abnormalities.Often, a normal electrocardiogram or a low brain natriuretic peptide (BNP) level can exclude left ventricular dysfunction. Unfortunately, the positive predictive value of both methods is not very high. 4,5 Electrocardiograms have a positive predictive value of 35% and a negative predictive value of 98% to detect or exclude heart failure. Measurement of plasma BNP gave a positive predictive value of 5 to 38% depending on the cut-off point and a negative predictive value of 92 to 100% in the Framingham Heart Study. 5 If there is still doubt about the aetiology of dyspnoea, echocardiography can help to differentiate between a cardiac cause and a non-cardiac cause. Besides this, it can also provide information about structural abnormalities that cause dyspnoea in certain patients. In an older population, not only the number of patients with heart failure increases, but also the incidence of hypertension and murmurs of unknown aetiology will rise. A correct diagnosis is not easy despite an extensive physical examination and auscultation. 6,7 Therefore, in the very south-east of the Netherlands (the Parkstad area) general practitioners were given the opportunity to ask for an echocardiogram without referring the patient to the department of cardiology. This was for

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Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient

Cited by 178 publications

References 14 publications

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

Comparison of Ultraportable Cardiac Echocardiography with Physical Examination for Diagnosis and Management during Cardiac Consultation Rounds

The Dutch experience of open access echocardiography

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