Pocket-sized Ultrasound versus Cardiac Auscultation in Diagnosing Cardiac Valve Pathologies: A Prospective Cohort Study

Authors

  • Lior Zeller
  • Lior Fuchs Ben Guruin University, Health sciences faculty
  • Tomer Maman
  • Tali Shafat Fainguelernt
  • Ianiv Fainguelernt
  • Leonid Barski
  • Noah Liel-Cohen
  • Sergio L. Kobal

DOI:

https://doi.org/10.5195/ijms.2021.1040

Keywords:

Auscultation, Diagnosis, Insonation, Medical students, Pocket ultrasound device, Point-of-care ultrasound, Valve disease

Abstract

Background: Pocket-sized ultrasound devices are used to perform focused ultrasound studies (POCUS). We compared valve malfunction diagnosis rate by cardiac auscultation to POCUS (insonation), both conducted by medical students.

Methods: A prospective cohort study was conducted among patients with and without clinically relevant valve dysfunction. Recruitment to the study group was based on the presence of at least one valve pathology of at least moderate severity identified on recent echocardiography study that was required for clinical reasons. Three final-year medical students examined the patients. Each patient underwent auscultation and a POCUS using a pocket-sized ultrasound machine. Sensitivity was defined as the percentage of patients correctly identified as having a valve disorder. Specificity was defined as correct identification of the absence of valve pathology.

Results: The study included 56 patients. In 18 (32%), no valve pathology was found. Nineteen patients (34%) had at least two valvular pathologies. Sixty valve lesions were present in the whole cohort. Students' sensitivity for detecting any valve lesion was 32% and 64% for auscultation and insonation; respectively, specificity was similar. 

 The sensitivity for diagnosing mitral regurgitation, mitral stenosis, and aortic regurgitation rose significantly by using POCUS compared to auscultation alone. When using POCUS, Students identified valve pathologies in 22 cases (39%) from the patients with at least two valve dysfunctions, and none when using auscultation.

Conclusions: Final-year medical students' competency to detect valve dysfunction by performing cardiac auscultation is poor. Cardiac ultrasound-focused training significantly improved medical students' sensitivity for diagnosing a variety of valve pathologies. 

References

Mangione S. Cardiac auscultatory skills of physicians-in-training: a comparison of three English-speaking countries. Am J Med. 2001;110(3):210-216.

Spencer KT, Anderson AS, Bhargava A, et al. Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient. J Am Coll Cardiol. 2001;37(8):2013-2018.

Sztajzel JM, Picard-Kossovsky M, Lerch R, Vuille C, Sarasin FP. Accuracy of cardiac auscultation in the era of Doppler-echocardiography: a comparison between cardiologists and internists. Int J Cardiol. 2010;138(3):308-310.

Mc Loughlin MJ, Mc Loughlin S. Cardiac auscultation: preliminary findings of a pilot study using continuous Wave Doppler and comparison with classic auscultation. Int J Cardiol. 2013;167(2):590-591.

Giannotti G, Mondillo S, Galderisi M, et al. Hand-held echocardiography: added value in clinical cardiological assessment. Cardiovasc Ultrasound. 2005;3:7.

Vourvouri EC, Koroleva LY, Ten Cate FJ, et al. Clinical utility and cost effectiveness of a personal ultrasound imager for cardiac evaluation during consultation rounds in patients with suspected cardiac disease. Heart. 2003;89(7):727-730.

Scholten C, Rosenhek R, Binder T, Zehetgruber M, Maurer G, Baumgartner H. Hand-held miniaturized cardiac ultrasound instruments for rapid and effective bedside diagnosis and patient screening. J Eval Clin Pract. 2005;11(1):67-72.

Culp BC, Mock JD, Chiles CD, Culp WC, Jr. The pocket echocardiograph: validation and feasibility. Echocardiography. 2010;27(7):759-764.

Prinz C, Voigt JU. Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr. 2011;24(2):111-116.

Khan HA, Wineinger NE, Uddin PQ, Mehta HS, Rubenson DS, Topol EJ. Can hospital rounds with pocket ultrasound by cardiologists reduce standard echocardiography? Am J Med. 2014;127(7):669 e661-667.

Mehta M, Jacobson T, Peters D, et al. Handheld ultrasound versus physical examination in patients referred for transthoracic echocardiography for a suspected cardiac condition. JACC Cardiovasc Imaging. 2014;7(10):983-990.

Kobal SL, Trento L, Baharami S, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol. 2005;96(7):1002-1006.

Stokke TM, Ruddox V, Sarvari SI, Otterstad JE, Aune E, Edvardsen T. Brief group training of medical students in focused cardiac ultrasound may improve diagnostic accuracy of physical examination. J Am Soc Echocardiogr.27(11):1238-1246.

Narula J, Chandrashekhar Y, Braunwald E. Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiol. 2018;3(4):346-350.

Blaufuss Multimedia - Heart Sounds and Cardiac Arrhythmias. Available http://www.blaufuss.org/

Vukanovic-Criley JM, Criley S, Warde CM, et al. Competency in cardiac examination skills in medical students, trainees, physicians, and faculty: a multicenter study. Arch Intern Med. 2006;166(6):610-616.

Huang CC, Lee PY, Chen PY, Liu TY. Design and implementation of a smartphone-based portable ultrasound pulsed-wave Doppler device for blood flow measurement. IEEE Trans Ultrason Ferroelectr Freq Control. 2012;59(1):182-188.

Solomon SD, Saldana F. Point-of-care ultrasound in medical education--stop listening and look. N Engl J Med. 2014;370(12):1083-1085.

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Published

2021-09-13

How to Cite

Zeller, L. ., Fuchs, L., Maman, T. ., Shafat Fainguelernt, T. ., Fainguelernt, I. ., Barski, L. ., Liel-Cohen, N. ., & L. Kobal, S. . (2021). Pocket-sized Ultrasound versus Cardiac Auscultation in Diagnosing Cardiac Valve Pathologies: A Prospective Cohort Study. International Journal of Medical Students. https://doi.org/10.5195/ijms.2021.1040

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Original Article