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Focused cardiac ultrasonography improves sensitivity for LV dysfunction vs. assessment alone
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Clinical examination with focused cardiac ultrasonography had greater sensitivity to identify patients with left ventricular dysfunction and mitral or aortic valve disease compared with clinical assessment alone, according to a study published in the Annals of Internal Medicine.
These results were not seen for specificity, according to the study.
“These results support the role of [focused cardiac ultrasonography] in ruling out clinically significant cardiovascular pathology in patients at low suspicion of disease; they also show the inability of [focused cardiac ultrasonography] to provide definitive confirmation of cardiovascular disease strongly suspected on physical examination,” Jeffrey A. Marbach, MBBS, MS, cardiology fellow in the department of medicine at University of Ottawa in Canada, and colleagues wrote.
Researchers analyzed data from 1,189 patients (median age, 64 years) from nine prospective and retrospective studies published between 1990 and May 23, 2019, that compared the diagnostic accuracy of clinical examination with focused cardiac ultrasonography vs. clinical assessment alone.
For the diagnosis of LV dysfunction, clinical examination with focused cardiac ultrasonography had a sensitivity of 84% (95% CI, 74-91) vs. 43% for clinical assessment alone (95% CI, 33-54). Specificity was 89% for clinical examination with focused cardiac ultrasonography (95% CI, 85-91) and 81% for clinical assessment alone (95% CI, 65-90).
Diagnosing mitral or aortic valve disease with clinical examination with focused cardiac ultrasonography had a sensitivity of 71% (95% CI, 63-79) compared with 46% for clinical assessment alone (95% CI, 35-58). Both methods had a specificity of 94% (95% CI, 91-96).
“Clinicians must recognize situations in which formal echocardiography should be pursued as well as the inherent limitations of [focused cardiac ultrasonography], in terms of both image acquisition and interpretation,” Marbach and colleagues wrote.
“After more than 2 centuries of using the stethoscope (sound) as the primary tool for bedside cardiac diagnosis, hand-held devices (ultrasound) are an exciting addition to the cardiac examination, but they are not without challenges related to proficiency, operator dependency and cost,” Nir Flint, MD, fellow in echocardiography research at Cedars-Sinai Heart Institute, and Robert J. Siegel, MD, the S. Rexford Kennamer, MD chair in cardiac ultrasound, medical director of the Clinic for Hypertrophic Cardiomyopathy and Aortopathies and professor of medicine at Cedars-Sinai, wrote in a related editorial. “With the advent of imaging, ‘seeing is believing,’ but the truth depends on the skills and expertise of the beholder.” – by Darlene Dobkowski
Disclosures: The authors of the study and the editorial report no relevant financial disclosures.
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