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.