November 1, 2015Open Access

Assessment of Primary Care Physicians' Use of a Pocket Ultrasound DeviceTM to Measure Left Ventricular Mass in Patients with Hypertension

PBPhilipp BornemannUniversity of South Carolina JJJohn Asher JohnsonUniversity of South Carolina STSamuel M. TiglaoMadigan Army Medical Center

Structured PICO

Does measurement of left ventricular mass index by primary care physicians using a pocket ultrasound device provide accurate results compared to standard echocardiography in patients with hypertension?

Population

101 adult patients (age ≥18 years) with a history of hypertension (blood pressure ≥140 systolic and/or ≥90 diastolic on 2 separate readings), mean age 60.5, 62.4% female, evaluated in an outpatient cardiology clinic or hospital wards.

Intervention

Measurement of left ventricular mass index (LVMI) by Primary Care Physicians (PCPs) using a pocket-sized ultrasound (pUS) device at the point of care, following a 4-hour training session.

Comparator

Measurement of LVMI by cardiologists using images obtained by echocardiography technicians on a high-end ultrasound machine (standard echocardiogram).

Outcome

Mean difference in left ventricular mass index (LVMI) between the PCP and cardiologist groups.surrogate

While primary care physicians can feasibly use pocket ultrasound to measure left ventricular mass, a brief 4-hour training session yields high variability and insufficient diagnostic accuracy for routine clinical use without further training and feedback.

Abstract

PURPOSE: Left ventricular hypertrophy (LVH) is common in primary care and is associated with increased morbidity and mortality. Treatment of underlying hypertension can reverse LVH and eliminate the associated risks. Electrocardiography is widely available and commonly used to screen hypertensive patients for LVH, but it is limited by low sensitivity. Limited echocardiographic measurement of the left ventricle is a method for screening with improved sensitivity; however, it is not currently widely used in the primary care setting. This study attempts to test the accuracy of primary care physicians' (PCPs) measurements of the left ventricle using a pocket-sized ultrasound (pUS) device after a brief training session. METHODS: This study was performed in an outpatient cardiology clinic by 3 family medicine residents and 1 family medicine faculty member after a 4-hour training session. Measurements of the left ventricle were made by PCPs using a pUS device; these measurements were compared with cardiologists' measurements from images obtained by echocardiography technicians. Left ventricular mass index (LVMI) was calculated based on these measurements and then compared between groups. RESULTS: There was no statistically significant difference between the mean LVMI calculations in the 2 groups. The agreement in measurements between the groups, however, showed high variability. This was manifested by the low sensitivity (70%) and specificity (76%) of PCPs in the detection of LVH. CONCLUSIONS: This study showed that limited echocardiography for the detection of LVH performed by PCPs at the point of care was feasible. Future studies are needed to determine the ideal training and experience necessary to yield competency.

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