Diagnostic influence of cardiovascular screening by pocket-size ultrasound in a cardiac unit

Kyrre Skjetne, Torbjørn Graven, Bjørn Olav Haugen, Øyvind Salvesen, Jens Olaf Kleinau, Håvard Dalen, Kyrre Skjetne, Torbjørn Graven, Bjørn Olav Haugen, Øyvind Salvesen, Jens Olaf Kleinau, Håvard Dalen

Abstract

Aims: We aimed to study the diagnostic influence of adding a routine cardiovascular ultrasound screening of the cardiac anatomy and function, the pericardium, the pleura and the abdominal great vessels by the new pocket-size ultrasound device (pUS) with grey scale and colour Doppler imaging.

Methods and results: In 119 randomly selected patients admitted to a cardiac unit at a non-university hospital, routinely adding a cardiovascular ultrasonography of only 4.4 min with a pocket-size device corrected the primary diagnosis in 16% of patients. In addition, 29% had the primary diagnosis verified and in 10% an additional important diagnosis was made. Higher age predicted any diagnostic influence of pUS screening with an increase of 61% (P=0.003) per 10 years of higher age. Overall, the pUS screening had a sensitivity and specificity with respect to detecting at least moderate pathology of 97 and 93%. Positive and negative predictive values were 93 and 87%, respectively. In the sub-group of subjects with a change in the primary diagnosis following pUS there was no false-negative or false-positive findings.

Conclusion: Screening by pUS assessed vascular and cardiac anatomy and function accurately and enabled correction of the diagnosis in 16% of patients admitted to a cardiac unit. In 55% of the participants, the cardiovascular ultrasound screening had important diagnostic influence. We suggest that it would be appropriate to implement strategies and systems for routinely adding an ultrasound cardiovascular examination to patients in cardiac units.

Figures

Figure 1
Figure 1
Age distribution of the 119 participants. Distribution deviated significantly from normal distribution (P < 0.001).
Figure 2
Figure 2
Diagnostic influence of cardiovascular ultrasound screening according to age. The probability of diagnostic influence of cardiovascular screening by pocket-size ultrasound according to the pre-stratified age groups. Error bars refer to 95% confidence interval.
Figure 3
Figure 3
Diagnostic influence of cardiovascular ultrasound screening of participants 40–79.9 years. Diagrams show diagnostic influence of cardiovascular screening by pocket-size ultrasound according to the pre-stratified age groups 40–59.9 (left) and 60–79.9 years (right).
Figure 4
Figure 4
Clinical case of a patient with change in diagnosis after examination with pUS. A 64-year-old woman was admitted with chest pain suspect of coronary ischaemia. Electrocardiogram showed T-wave inversions in precordial leads (left figure). Bedside screening with pocket-sized device revealed dissection of the ascending aorta (right figure; modified five-chamber view), aneurysm of the ascending aorta and aortic regurgitation. Dissection membrane was also visible in the abdominal aorta. She was transferred to the regional university hospital for surgery. See Supplementary data online, video loops.

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Source: PubMed

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