Comparison of Ultraportable Cardiac Echocardiography with Physical Examination for Diagnosis and Management during Cardiac Consultation Rounds

Abstract

Introduction: The purpose of this study was to compare the results of physical examinations (PEs) performed by a cardiologist with the results of point-of-care echocardiography for the diagnosis and management of patients during cardiac consultation rounds. Patients and Methods: In all, 265 hospitalized consecutive patients from non-cardiac units (age, 62 ± 11; male, 56%) were included after complete cardiovascular (CV) examination by a consulting cardiologist. After the PE, the consulting cardiologist imaged each patient using a hand-carried cardiac ultrasound (HCU). All patients subsequently underwent a study with a standard echocardiographic device (SED) as the gold standard, performed on an upper-end platform. Definitive diagnosis, management change, and modifying diagnostic workup were also assessed. Results: There were 196 CV findings detected with an SED in this patient population. Of these, PE failed to detect 41% of the overall CV findings and HCU missed 23% of the overall CV pathology. Overall, HCU had an effect on patient treatment decisions in 149 patients (56%); 42% had a change in medical therapy and 21% had a change in their diagnostic workup (most with changes in both). Conclusion: HCU echocardiographic assessment during consultation rounds improved the detection of significant CV pathology. Also, a direct assessment of cardiac function and anatomy at the bedside by an experienced cardiologist with HCU as a routine adjunct to PE results in an important change in clinical management and diagnostic workup during consultation.