Clinical Investigation
Echocardiography at the “Point of Care”
Usefulness of a New Miniaturized Echocardiographic System in Outpatient Cardiology Consultations as an Extension of Physical Examination

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Background

The aim of this study was to assess the usefulness of a new miniaturized echocardiographic system (MS) to perform bedside echocardiography in initial outpatient cardiology consultations, in addition to physical examination.

Methods

One hundred eighty-nine patients referred for initial cardiology outpatient consultations at two tertiary hospitals in two countries were studied. Each patient was submitted to physical examination followed by MS assessment. Scanning time, the number of examinations with abnormal results after physical examination and the MS, and the information obtained by physical examination alone and followed by the MS (in terms of its importance in reaching a diagnosis, in the necessity of performing routine echocardiography, and in the decision to release the patient from the outpatient clinic) were assessed.

Results

The scanning time with the MS was 180 ± 86 seconds. Its use after physical examination led to diagnoses in 141 patients (74.6%) and to an additional 37 patients (19.6%) being released from the outpatient clinic. After physical examination followed by MS assessment, only 64 patients (33.9%) were sent to the echocardiography lab. The MS modified the decision of whether to send a patient to the echocardiography lab, with referral determined by the MS in 27 patients (14.3%) and no referral determined by the MS in 58 patients (30.7%).

Conclusions

The new MS caused a negligible increase in the duration of consultations. It showed additive clinical value over physical examination, increasing the number of diagnoses, reducing the use of unnecessary routine echocardiography, increasing the number of adequate echocardiographic studies, and determining a large number of releases from the outpatient clinic.

Section snippets

Methods

This study took place at two tertiary hospitals in two different countries (University Hospital San Carlos, Madrid, Spain, and Hospital da Luz, Lisbon, Portugal). The MS used was the V-Scan (GE Vingmed Ultrasound AS, Horten, Norway). This ultrasound device consists of a display unit (135 × 73 × 28 mm) connected to a broad-bandwidth phased-array probe (1.7–3.8 MHz; 120 × 33 × 26 mm). Its total weight (unit and probe) is 390 g. The total possible scanning time is 1 hour with a fully charged

Results

We studied 189 patients (mean age, 53 ± 16 years; age range, 14–89 years; 99 male [52.4%], 90 female [47.6%]).

Discussion

Since their development about 40 years ago, the use of hand-held echocardiographic systems has been a controversial issue,6, 7, 8, 9, 10, 11, 12, 13, 14 specifically with regard to their diagnostic accuracy, the clinical scenarios in which they should be used, and the identification of their potential users and their competence level.17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28

Nowadays, the first issue is no longer an important subject of debate. Technological evolution has led to the

Conclusions

The new MS in outpatient cardiology consultations as an extension of physical examination caused a negligible increase in the duration of the consultations. It showed additive clinical value over the physical examination, contributing to an increased number of diagnoses, reducing the performance of unnecessary conventional echocardiographic studies, increasing the number of adequate echocardiograms, and allowing many patients to be released from the outpatient clinic without the need for

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