Prime time for handheld echocardiography in COVID-19 pandemic

Editor – We are in unprecedented times as the world tries to combat the 2019 novel coronavirus (COVID-19). It is imperative that innovative technologies limiting the spread of COVID-19 within healthcare settings are introduced as initial reports estimate that 3.5% of healthcare workers are becoming infected.

There is much evidence supporting the use of handheld echocardiography (HHE) techniques to augment physical findings during the cardiovascular examination. Now, is the prime time for clinical translation of HHE, mainly to reduce the number of transthoracic echocardiography (TTE) procedures. TTE remains the first-line imaging test for the assessment of cardiovascular disease. TTE systems tend to be bulky, wired for electrical supply and have huge non-sterile exposed areas (keyboard, screens, base-unit) where SARS-CoV-2 could survive for days. Alternatively, HHE devices are small, cheaper, lightweight and only require a single clinician at the bedside as images can be sent wirelessly. Disposable ultrasound probe covers can almost seal these devices limiting any cross-infection. Furthermore, HHE devices have evolved to not only provide B-mode but also include colour Doppler for valvular assessment. Paradoxically, the clinical need for HHE is even more relevant in the current pandemic, as COVID-19 has several cardiovascular clinical presentations. In suspected ST-elevation myocardial infarction, HHE can differentiate left ventricular regional wall motion abnormality versus global dysfunction, the latter favouring a diagnosis of COVID-19 myocarditis. These applications make HHE a far more appropriate option while echocardiography procedures are being rationalised due to high-risk of transmission.^1–3

Operability of HHE by medical students and inexperienced clinicians can be obtained rapidly and provide more accurate diagnostic results compared with clinical examination.^4,5 Thus, there is an urgent need to address these training requirements through the British Society of Echocardiography.

We conclude that HHE can reduce the scanning time, possibly the risk of transmission and minimise costs, while providing reasonable diagnostic information. This will help achieve the goal of protecting patients and healthcare workers. Ultimately, this may lead to a change in standard practice following COVID-19 as the benefits of bedside HHE are realised.