Key result
Handheld ultrasound devices used by experienced operators accurately diagnosed moderate/severe reduced LVEF with a diagnostic OR of 276, outperforming inexperienced users.
Why the study?
This study evaluated the diagnostic ability of handheld ultrasound devices compared with transthoracic echocardiography for assessing left ventricular dysfunction and evaluated the impact of operator experience.
Does handheld ultrasound device imaging accurately diagnose left ventricular dysfunction compared to transthoracic echocardiography in patients with suspected LV dysfunction?
Meta-Analysis (n=6,062)
Does handheld ultrasound device imaging accurately diagnose left ventricular dysfunction compared to transthoracic echocardiography in patients with suspected LV dysfunction?
Handheld ultrasound devices provide high diagnostic accuracy for assessing left ventricular size and function, particularly when used by experienced operators, supporting their use as an auxiliary tool to physical examination.
Answers are grounded in this paper and cite their sources.
Supports HUD adoption by experienced operators for LV assessment; confirms high diagnostic performance versus transthoracic echocardiography.
OBJECTIVE: Handheld ultrasound devices (HUD) has diagnostic value in the assessment of patients with suspected left ventricular (LV) dysfunction. This meta-analysis evaluates the diagnostic ability of HUD compared with transthoracic echocardiography (TTE) and assesses the importance of operator experience. METHODS: MEDLINE and EMBASE databases were searched in October 2020. Diagnostic studies using HUD and TTE imaging to determine LV dysfunction were included. Pooled sensitivities and specificities, and summary receiver operating characteristic curves were used to determine the diagnostic ability of HUD and evaluate the impact of operator experience on test accuracy. RESULTS: Thirty-three studies with 6062 participants were included in the meta-analysis. Experienced operators could predict reduced LV ejection fraction (LVEF), wall motion abnormality (WMA), LV dilatation and LV hypertrophy with pooled sensitivities of 88%, 85%, 89% and 85%, respectively, and pooled specificities of 96%, 95%, 98% and 91%, respectively. Non-experienced operators are able to detect cardiac abnormalities with reasonable sensitivity and specificity. There was a significant difference in the diagnostic accuracy between experienced and inexperienced users in LV dilatation, LVEF (moderate/severe) and WMA. The diagnostic OR for LVEF (moderate/severe), LV dilatation and WMA in an experienced hand was 276 (95% CI 58 to 1320), 225 (95% CI 87 to 578) and 90 (95% CI 31 to 265), respectively, compared with 41 (95% CI 18 to 94), 45 (95% CI 16 to 123) and 28 (95% CI 20 to 41), respectively, for inexperienced users. CONCLUSION: This meta-analysis is the first to establish HUD as a powerful modality for predicting LV size and function. Experienced operators are able to accurately diagnose cardiac disease using HUD. A cautious, supervised approach should be implemented when imaging is performed by inexperienced users. This study provides a strong rationale for considering HUD as an auxiliary tool to physical examination in secondary care, to aid clinical decision making when considering referral for TTE. TRIAL REGISTRATION NUMBER: CRD42020182429.
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Jenkins et al. (2021) conducted a meta-analysis in Suspected left ventricular (LV) dysfunction (n=6,062). Handheld ultrasound devices (HUD) vs. Transthoracic echocardiography (TTE) / Inexperienced users was evaluated on Diagnostic accuracy for moderate/severe reduced LVEF (OR 276, 95% CI 58-1320). Handheld ultrasound devices used by experienced operators accurately diagnosed moderate/severe reduced LVEF with a diagnostic OR of 276, outperforming inexperienced users.
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