HAND held echocardiography a dangerous toy?

Transcription

1 HAND held echocardiography a dangerous toy? Eva Gerdts Professor of Medicine University of Bergen Visiting Professor of Medicine Federico II University, Napoli

2 Diagnostic accuracy Vscan vs high end echocardiograph 349 consecutive routine patients (56% men) Age mean 61.5 (20-89) years BMI mean 25.8 (15-48) kg/m 2 Visually assessed EF Blant Altman Plot Voigt JU. JASE 2011

3 Performing high quality echocardiography requires SKILLS The examinations with HAND were performed by an experienced cardiologist after informed consent was obtained, directly before or after the regular echocardiographic examination with the HIGH scanner, which was performed independently by an experienced echocardiographer. Voigt JU. JASE 2011

4 Valve regurgitation is accurately assessed by Vscan All regurgitations graded 0-4 based on cardiac morphology and color flow regurgitation Areg: 6.3% missed by HAND. κ= 0.94, p<0.01 Mreg: 2.6% missed by HAND. κ= 0.80, p<0.01 Treg: 10.2% missed by HAND. κ=0.60, p<0.01 Voigt JU. JASE 2011

5 Aortic stenosis severity is underestimated AS was graded by combining valve morphology and color Doppler 21 pts had AS (6%) HAND Classified 11 correctly Underestimated 10 κ= 0.21, p>0.5 by Vscan Voigt JU. JASE 2011

6 NAUSICA study NApoli UltraSound In CArdiology Study Vscan performance Additive value to physical examination Comparison between trainees and cardiologists Compared to standard echocardiography 304 patients referred from Department of endocrinology and oncology Federico II University Hospital for echocardiography Physical examination + Vscan + standard echo Vscan on average 5 duration Galderisi M, de Simone G. Cardiovasc Ultrasound 2010

7 Echocardiographic abnormalities in the NAUSICA study not detected by physical examination Cardiac abnormality 38.2% by physical examination (PE) 67.8% if PE + Vscan by trainee 73.5% if PE + Vscan by cardiologist Galderisi M, de Simone G. Cardiovasc Ultrasound 2010

8 NAUSICA study Vscan vs. standard echocardiograph Abnormality K overall K experts (n=102) K trainees (n=202) Overall Reduced EF Dilated atrium Dilated aorta Dilated RV Dilated IVC Mreg Areg Valve calcification Pericardial effusion Pleural effusion Galderisi M, de Simone G. Cardiovasc Ultrasound 2010

9 Diagnostic accuracy in NAUSICA study relation to SKILLS Overall Cardiologists vs. Trainees Galderisi M, de Simone G. Cardiovasc Ultrasound 2010

10 Proposed training for Vscanning by LV EF LV wall thickness Valve calcification Pericardial effusion Pleural effusion RV dilatation IVC dimension and reactivity Mitral regurgitation Tricuspid regurgitation Extravascular lung water non-cardiologists Galderisi M, de Simone G. Cardiovasc Ultrasound 2010

11 EAE position on pocket-size imaging devices Pocket-size imaging devices are NOT echocardiographs Technical characteristics 2D and color Doppler modalities 2D image sector <75 Depth <25 cm Color Doppler fixed box size and pulse repetition frequency Measure only distance and area Limited identification of patients Limited connectivity Sicari R. Eur J Echocardiogr 2011

12 EAE Indications for pocket-size devices Complement to a physical examination in the CCU or ICU Tool for a fast initial screening in an emergency setting First cardiac evaluation in ambulances Screening programs Triaging candidates for a complete echocardiography Semiquantification of extravascular lung water Sicari R. Eur J Echocardiogr 2011

13 EAE required training to operate pocket-size imaging devices Cardiologists with expertise in echocardiography do not need targeted training Non-cardiologists/other medical professionals need dedicated training Basic cardiac physiology Cardiac pathology Echocardiography Sicari R. Eur J Echocardiogr 2011

14 HAND held echocardiography a dangerous toy? YES, if used by non-cardiologists without targeted training Under AND over diagnosis of severe disease If used as replacement for echocardiography If used by un-trained non-cardiologist delays adequate echocardiography NO, if used as extended physical examination by cardiologists