Khan Hashim A, Wineinger Nathan E, Uddin Poulina Q, Mehta Hirsch S, Rubenson David S, Topol Eric J
Division of Cardiovascular Diseases, Scripps Clinic, Scripps Health, La Jolla, Calif; Scripps Translational Science Institute, La Jolla, Calif.
Scripps Translational Science Institute, La Jolla, Calif.
Am J Med. 2014 Jul;127(7):669.e1-7. doi: 10.1016/j.amjmed.2014.03.015. Epub 2014 Mar 24.
Frequently, hospitalized patients are referred for transthoracic echocardiograms. The availability of a pocket mobile echocardiography device that can be incorporated on bedside rounds by cardiologists may be a useful and frugal alternative.
This was a cross-sectional study designed to compare the accuracy of pocket mobile echocardiography images with those acquired by transthoracic echocardiography in a sample of hospitalized patients. Each patient referred for echocardiography underwent pocket mobile echocardiography acquisition and interpretation by a senior cardiology fellow with level II training in echocardiography. Subsequently, transthoracic echocardiography was performed by skilled ultrasonographers and interpreted by experienced echocardiographers. Both groups were blinded to the results of the alternative imaging modality. Visualizability and accuracy for all key echocardiographic parameters (ejection fraction, wall motion abnormalities, left ventricular end-diastolic dimension, inferior vena cava size, aortic and mitral valve pathology, and pericardial effusion) were determined and compared between imaging modalities.
A total of 240 hospitalized patients underwent echocardiography with pocket mobile echocardiography and transthoracic echocardiography. The mean age was 71 ± 17 years. Pocket mobile echocardiography imaging time was 6.3 ± 1.5 minutes. Sensitivity of pocket mobile echocardiography varied by parameter and was highest for aortic stenosis (97%) and lowest for aortic insufficiency (76%). Specificity also varied by parameter and was highest for mitral regurgitation (100%) and lowest for left ventricular ejection fraction (92%). Equivalence testing revealed the pocket mobile echocardiography outcomes to be significantly equivalent to the transthoracic echocardiography outcomes with no discernible differences in image quality between pocket mobile echocardiography and transthoracic echocardiography (P = 7.22 × 10(-7)). All outcomes remain significant after correcting for multiple testing using the false discovery rate.
The results from rapid bedside pocket mobile echocardiography examinations performed by experienced cardiology fellows compared favorably with those from formal transthoracic echocardiography studies. For hospitalized patients, this finding could shift the burden of performing and interpreting the echocardiogram to the examining physician and reduce the number and cost associated with formal echocardiography studies.
住院患者经常需要接受经胸超声心动图检查。心内科医生在床边查房时能够使用的便携式移动超声心动图设备可能是一种实用且经济的替代选择。
这是一项横断面研究，旨在比较便携式移动超声心动图图像与经胸超声心动图在住院患者样本中所获取图像的准确性。每例接受超声心动图检查的患者均由接受过二级超声心动图培训的高级心内科住院医师进行便携式移动超声心动图的采集和解读。随后，由熟练的超声检查技师进行经胸超声心动图检查，并由经验丰富的超声心动图医生进行解读。两组人员均对另一种成像方式的结果不知情。确定并比较了两种成像方式对于所有关键超声心动图参数（射血分数、室壁运动异常、左心室舒张末期内径、下腔静脉大小、主动脉瓣和二尖瓣病变以及心包积液）的可视性和准确性。
共有240例住院患者接受了便携式移动超声心动图和经胸超声心动图检查。平均年龄为71±17岁。便携式移动超声心动图的成像时间为6.3±1.5分钟。便携式移动超声心动图的敏感性因参数而异，主动脉狭窄时最高（97%），主动脉瓣关闭不全时最低（76%）。特异性也因参数而异，二尖瓣反流时最高（100%），左心室射血分数时最低（92%）。等效性检验显示，便携式移动超声心动图的结果与经胸超声心动图的结果显著等效，便携式移动超声心动图与经胸超声心动图之间的图像质量无明显差异（P = 7.22×10⁻⁷）。使用错误发现率校正多重检验后，所有结果仍然显著。
由经验丰富的心内科住院医师进行的快速床边便携式移动超声心动图检查结果与正式的经胸超声心动图检查结果相比具有优势。对于住院患者而言，这一发现可能会将超声心动图检查和解读的负担转移至检查医生身上，并减少与正式超声心动图检查相关的数量和成本。
