Original Research
Handheld Ultrasound Versus Physical Examination in Patients Referred for Transthoracic Echocardiography for a Suspected Cardiac Condition

https://doi.org/10.1016/j.jcmg.2014.05.011Get rights and content
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Abstract

Objectives

The purpose of this study was to test the hypothesis that handheld ultrasound (HHU) provides a more accurate diagnosis than physical examination in patients with suspected cardiovascular abnormalities and that its use thus reduces additional testing and overall costs.

Background

Despite the limitations of physical examination and the demonstrated superiority of HHU for detecting cardiac abnormalities, it is not routinely used for the bedside diagnosis of cardiac conditions.

Methods

Patients referred for a standard echocardiogram for common indications (cardiac function, murmur, stroke, arrhythmias, and miscellaneous) underwent physical examination and HHU by different cardiologists, who filled out a form that also included suggestions for additional testing, if necessary, based on their findings.

Results

Of 250 patients, 142 had an abnormal finding on standard echocardiogram. Of these, HHU correctly identified 117 patients (82%), and physical examination correctly identified 67 (47%, p < 0.0001). HHU was superior to physical examination (p < 0.0001) for both normal and abnormal cardiac function. It was also superior to physical examination in correctly identifying the presence of substantial valve disease (71% vs. 31%, p = 0.0003) and in identifying miscellaneous findings (47% vs. 3%, p < 0.0001). Of 108 patients without any abnormalities on standard echocardiography, further testing was suggested for 89 (82%) undergoing physical examination versus only 60 (56%) undergoing HHU (p < 0.0001). Cost modeling showed that HHU had an average cost of $644.43 versus an average cost of $707.44 for physical examination. This yielded a savings of $63.01 per patient when HHU was used versus physical examination.

Conclusions

When used by cardiologists, HHU provides a more accurate diagnosis than physical examination for the majority of common cardiovascular abnormalities. The finding of no significant abnormality on HHU is also likely to result in less downstream testing and thus potentially reduce the overall cost for patients being evaluated for a cardiovascular diagnosis.

Key Words

cardiac diagnosis
handheld ultrasound
physical examination

Abbreviations and Acronyms

BMI
body mass index
HHU
handheld ultrasound
LV
left ventricular
RV
right ventricular

Cited by (0)

This research was supported in part by a research grant from GE Medical, Milwaukee, Wisconsin and was presented in part at the 2013 annual scientific sessions of the American College of Cardiology in San Francisco, California, the American Society of Echocardiography in Minneapolis, Minnesota, and the American Heart Association in Dallas, Texas. Dr. Caughey serves as a medical advisor to CellScape, Ariosa Diagnostics, and MindChild Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.