PubMed · 15245333
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Arthur J Moss. 2004. Exercise testing.. https://doi.org/10.1111/j.1542-474x.2004.93001.x
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BACKGROUND: Hand-carried ultrasound (HCU) devices have been demonstrated to improve the diagnosis of cardiac diseases over physical examination, and have the potential to broaden the versatility in ultrasound application. The role of these devices in the assessment of hospitalized patients is not completely established. In this study we sought to perform a direct comparison between bedside evaluation using HCU and comprehensive echocardiography (CE), in cardiology inpatient setting. METHODS: We studied 44 consecutive patients (mean age 54 +/- 18 years, 25 men) who underwent bedside echocardiography using HCU and CE. HCU was performed by a cardiologist with level-2 training in the performance and interpretation of echocardiography, using two-dimensional imaging, color Doppler, and simple calliper measurements. CE was performed by an experienced echocardiographer (level-3 training) and considered as the gold standard. RESULTS: There were no significant differences in cardiac chamber dimensions and left ventricular ejection fraction determined by the two techniques. The agreement between HCU and CE for the detection of segmental wall motion abnormalities was 83% (Kappa = 0.58). There was good agreement for detecting significant mitral valve regurgitation (Kappa = 0.85), aortic regurgitation (kappa = 0.89), and tricuspid regurgitation (Kappa = 0.74). A complete evaluation of patients with stenotic and prosthetic dysfunctional valves, as well as pulmonary hypertension, was not possible using HCU due to its technical limitations in determining hemodynamic parameters. CONCLUSION: Bedside evaluation using HCU is helpful for assessing cardiac chamber dimensions, left ventricular global and segmental function, and significant valvular regurgitation. However, it has limitations regarding hemodynamic assessment, an important issue in the cardiology inpatient setting.
With the vast epidemic of vascular disease predicted to be the leading cause of death and disability by a growing margin over the next 30 years, academic medical centers with cardiology training programs have a special responsibility. Given the dramatic advances of biotechnology in producing highly effective but expensive strategies of prevention and treatment, cardiovascular specialists should assist their academic centers in envisioning the future to prepare trainees for a different environment. Cardiologists of the future must be able to adapt to a societal need for patient-oriented, team-based clinical care and rapidly evolving technology, while maintaining the fundamental skills and knowledge required for individual patient interaction. Academic programs should benchmark their activities to ensure responsible resource allocation so that cardiologists of the future will be trained in an environment stimulating excellence and creativity.