Discussion
This study demonstrates that handheld imaging stools like the Vscan
Extend (GE, Wisconsin) are easily adopted by previously untrained users
and can reliably detect VHD, assess LVEF, and extra-cardiac findings
with comparable accuracy to expert echocardiography readers. Integrating
history taking and clinical examination with POCE in the primary care
setting is feasible and may help relieve the community’s burden of
undiagnosed VHD. Further, we may be able to close the current gap in
diagnosing and treating severe VHD in our patient population.
Various studies have reported comparable results between handheld
technology and standard echocardiograms concerning cardiac function,
left ventricular systolic dysfunction (LVSD), and valve
regurgitation(7-9). A recent study done by Olesen et al. used both
standard and handheld echocardiography to evaluate LVSD in persons 75
years and older and found comparable quality and reliability between
handheld echocardiography and standard echocardiography(8). The
comparison showed good level of agreement in diagnosing LVSD and cardiac
function(8). Another study by Kitada et al.(9) compared the diagnostic
accuracy of handheld and standard echocardiography to measure cardiac
chamber size and function and assess valvular regurgitation(9). They
found a strong level of agreement between the handheld and standard
echocardiography, both performed and interpreted by experts, in
assessing cardiac structure and functionality(9). The handheld echo also
accurately detected all valvular stenosis cases observed in the patient
cohort, making it useful in assessing significant valvular disease(9).
Similarly, Williams et al, studied the use of handheld echocardiography
in the primary care setting for VHD screening in the elderly population,
performed by an experienced sonographer. Of the 100 patients included,
13 patients had at least moderate AS or moderate MR, and five of the 100
needed a valve replacement or follow-up at a valve clinic based on the
findings of the handheld scanner(11). The handheld scanner allowed for
early intervention and referrals for patients. Perez et al.(12)
conducted a study assessing handheld echocardiographic devices’ accuracy
compared to standard echocardiography in an oncology clinic. In 101
patients, the study showed good concordance between the two in
evaluating cardiac function in patients under chemotherapy(12). Similar
levels of inter-reader variability in assessing LV function have been
discussed in one further study, where one reader was an expert
echocardiographer and the other a well-trained intensivist(13).
In our study, the detection of tricuspid or mitral regurgitation had
comparable accuracy between the expert readers and previously untrained
providers using the Vscan Extend (GE, Wisconsin). Further, a similar
accuracy was noted when assessing pericardial, pleural effusion, and
patient’s volume status. The assessment of aortic stenosis (2D only) and
LV function had a moderate level of agreement between the trained
providers and expert readers.
In the context of the here discussed prior studies, that mostly relied
on expert echocardiographers’ scanning, our study demonstrates the rapid
adoptability and high accuracy of handheld echocardiography by
previously untrained providers in the assessment of VHD. Handheld
echocardiography has promise in becoming an ideal tool for early
identification of VHD in the primary care setting.