Point-of-Care Ultrasound versus Routine Transthoracic Echocardiography for Screening of Cardiovascular Disease in Pregnant Women

Background The Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women (PRESAP) is a registry designed for the echocardiographic screening of structural heart disease (SHD). It offers a unique opportunity to compare the effectiveness of point-of-care ultrasound (POCUS) versus routine transthoracic echocardiography (TTE) in this population. Objectives This sub-study of the PRESAP registry aimed to compare the detection of SHD in asymptomatic pregnant women using POCUS versus routine TTE. Methods Between February 2023 and March 2024, pregnant women without known heart disease were enrolled in the PRESAP registry. Participants underwent a limited echocardiogram, using either POCUS or TTE. The primary outcome was the detection of abnormal findings, including left ventricular systolic dysfunction (LVSD), valvular heart disease (VHD), and congenital heart disease (CHD). Matching cohorts were created using propensity score matching, based on demographic factors, comorbid conditions, and gestational history. Results Among 18,401 patients, 9,681 (52.6%) underwent POCUS. The 1:1 propensity-matched cohort included 4,177 patients in each arm. Abnormal echocardiographic findings were detected in 4.4% (185) of the TTE group and 3% (124) of the POCUS group (p<0.001). VHD (1.3% vs. 1.1%; p=0.416) and CHD (0.4% vs. 0.6%; p=0.093) were detected at similar rates by both methods, while LVSD was more frequently identified by TTE compared to POCUS (2.8% vs. 1.5%; p<0.001). Conclusions POCUS may be considered as an alternative to TTE for screening for SHD in asymptomatic pregnant women, particularly in resource-limited settings. TTE was superior for LVSD, POCUS was equally effective in identifying valvular and congenital heart disease.