Diagnostic accuracy of handheld cardiac ultrasound device for assessment of left ventricular structure and function: systematic review and meta-analysis
Autor: | Vassilios S. Vassiliou, Sam Jenkins, Samer Alabed, Alisdair Ryding, Benoy N. Shah, Peter P Swoboda, Gabriel Marques, Chris Sawh, Robin Nijveldt, Roxy Senior, Andrew J. Swift, James Wardley, Pankaj Garg |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Left ventricular structure Ejection fraction medicine.diagnostic_test Receiver operating characteristic business.industry Diagnostic accuracy Physical examination 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Meta-analysis Internal medicine medicine Cardiology Medical imaging Cardiac Imaging Techniques 030212 general & internal medicine Cardiology and Cardiovascular Medicine business |
ISSN: | 4202-0182 1355-6037 |
Popis: | ObjectiveHandheld 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.MethodsMEDLINE 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.ResultsThirty-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.ConclusionThis 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 numberCRD42020182429. |
Databáze: | OpenAIRE |
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