Pocket-size echo a practical, reliable diagnostic tool

The use of pocket-size echocardiography at a patient’s bedside can provide reliable diagnostic information, even if medical residents who perform the tests have limited ultrasound experience. In a study published in the December issue of European Heart Journal – Cardiovascular Imaging, researchers found that with three months of training, residents could obtain valuable information in less than six minutes.

Investigators led by Ole Christian Mjolstad, MD, of the Norwegian University of Science and Technology in Trondheim, Norway, sought to determine whether using pocket-size hand-held echocardiographic (PHHE) devices were practical and could yield reliable information. They used a Vscan device (GE Vingmed Ultrasound) in the study.

They enrolled 199 patients at Levanger Hospital in Norway between April and June of 2011. Six medical residents performed the examinations of these patients and after receiving standard care, each patient underwent testing with PHHE. The residents received several months of training prior to using the devices. To validate the findings of the PHHE examinations, experienced cardiologists performed standard echocardiography.

On average, the PHHE examinations took 5.7 minutes. Residents were able to satisfactorily assess left ventricular function in 97 percent of patients and the pericardial space in all patients. They were able to examine the aortic and atrioventricular valves in at least 76 percent of patients and the pulmonic value in less than 50 percent. The abdominal aorta was assessed well in 50 percent of the patients and the inferior vena cava in 77 percent.

Left ventricular function, pleural and pericardial effusion correlated strongly with standard procedures as did the determination of the degree of aortic stenosis and regurgitation and the quantification of the abdominal aorta. Atrioventricular, mitral and tricuspid valve regurgitations correlated moderately with standard procedures. Dilatation of the left atrium and regional dysfunction determination were also moderately correlated, as was the diameter of the inferior vena cava.

The authors said their findings suggest that PHHE could be a valuable and feasible addition to clinicians’ diagnostic arsenal provided there is adequate training in use of the device. They stressed it cannot replace standard echocardiography performed by experienced staff.

“Taking a thorough medical history and performing a physical examination will remain the cornerstones in the diagnostic procedure, but there is a need for improvement in diagnostic accuracy to decrease medical errors,” they wrote. “PHHE is an excellent tool to provide further diagnostic information.”