This is an outdated version published on 2021-12-16. Read the most recent version.

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. 

Metrics

Metrics Loading ...

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.

Downloads

Published

2021-12-16

Versions

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, 9(4). https://doi.org/10.5195/ijms.2021.1040

Issue

Vol. 9 No. 4 (2021)

Section

Original Article

Categories

License

Copyright (c) 2021 Lior Zeller, Lior Fuchs, Tomer Maman, Tali Shafat Fainguelernt, Ianiv Fainguelernt, Leonid Barski, Noah Liel-Cohen, Sergio L. Kobal

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
    2. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
    3. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
    4. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
    5. The Author represents and warrants that:
      1. the Work is the Author’s original work;
      2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
      3. the Work is not pending review or under consideration by another publisher;
      4. the Work has not previously been published;
      5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
      6. the Work contains no libel, invasion of privacy, or other unlawful matter.
    6. The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Enforcement of copyright

The IJMS takes the protection of copyright very seriously.

If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.

If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org

 

Infringing material

If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org