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Adoptability and Accuracy of Point-of-Care Ultrasound in Screening for Valvular Heart Disease in the Primary Care setting
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  • Yashasvi Chugh,
  • Opema Lohese,
  • Paul Sorajja,
  • Ross Garberich,
  • Lariss Stanberry,
  • Joao Cavalcante,
  • Mario Gossl
Yashasvi Chugh
Minneapolis Heart Institute at Abbott Northwestern Hospital
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Opema Lohese
Minneapolis Heart Institute at Abbott Northwestern Hospital
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Paul Sorajja
Minneapolis Heart Institute at Abbott Northwestern Hospital
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Ross Garberich
Minneapolis Heart Institute at Abbott Northwestern Hospital
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Lariss Stanberry
Minneapolis Heart Institute at Abbott Northwestern Hospital
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Joao Cavalcante
Minneapolis Heart Institute at Abbott Northwestern Hospital
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Mario Gossl
Minneapolis Heart Institute at Abbott Northwestern Hospital
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Abstract

Background: Despite continued efforts, the majority of patients with valvular heart disease (VHD) remain undiagnosed and untreated. This study aimed to assess the adoptability and accuracy of point-of-care handheld echocardiographic assessments (POCE) in the primary care setting. Methods: Eleven previously untrained primary care providers were trained to use the Vscan Extend (GE, WI) POCE to assess VHD, left ventricular function (LVEF), and major extra-cardiac findings. Their assessments were compared to those of 3 blinded expert readers. A total of 180 assessments were evaluated using Kappa statistics (κ) together with their estimated standard error, p-value, and 95% CI bounds. Results: Identical or nearly identical agreement between previously untrained primary providers and expert readers was evident for the diagnosis of tricuspid regurgitation, mitral regurgitation, pericardial effusion, volume status. These agreements were strongest in apical long axis (κ =1, p<0.001) and parasternal long and short axis views (k>=0.82 p<0.001), though agreement remained robust in apical 4-chamber views (k>=0.76). The agreements in LVEF assessment were identical in the apical long axis view (κ =1, p<0.001) and robust in the remaining 3 views (κ>=0.66, p<0.001). The assessments of aortic stenosis (parasternal/long, κ =0.42, and parasternal/short, κ =0.47, both p<0.001) were weak in their agreement. Conclusion: Compared to expert echocardiography readers, the untrained providers’ use of POCE for VHD shows high user adoptability and diagnostic accuracies in the primary care setting.

Peer review status:UNDER REVIEW

02 Feb 2021Submitted to Echocardiography
03 Feb 2021Submission Checks Completed
03 Feb 2021Assigned to Editor
08 Feb 2021Reviewer(s) Assigned
11 Mar 2021Review(s) Completed, Editorial Evaluation Pending
15 Mar 2021Editorial Decision: Revise Major
24 Mar 20211st Revision Received
26 Mar 2021Submission Checks Completed
26 Mar 2021Assigned to Editor
26 Mar 2021Reviewer(s) Assigned
03 Apr 2021Review(s) Completed, Editorial Evaluation Pending