Physician-performed point-of-care echocardiography using a laptop platformcompared with physical examination in the cardiovascular patient

Objectives The purpose of this study was to compare the results of physical examinations (PEs) performed by board-certified cardiologists with the res ults of point-of-care (POC) echocardiography in a group of patients with ca rdiovascular disease. Background Although cardiovascular PE is crucial in the evaluation of patie nts with suspected heart disease, the skills required to diagnose abnormal cardiovascular findings have been declining. Echocardiography is a powerful noninvasive cardiovascular diagnostic tool; however, echocardiographic eva luation of patients is not performed at the time of patient encounter (POC echocardiography), because current platforms are cumbersome and expensive f or individual physician use. The development of miniaturized echocardiograp hic equipment has the potential to overcome some of these limitations. Methods Thirty-six subjects had a complete cardiovascular examination by fo ur board-certified cardiologists. The physicians subsequently imaged each p atient using a miniaturized echocardiographic platform. The yield of PE and POC echocardiography were compared using a complete echocardiographic stud y as the gold standard, performed on an upper-end platform. Results Cardiac examination failed to detect 59% of the overall cardiovascu lar findings. Physician-performed echocardiography with the prototype devic e missed 29% of the overall cardiovascular pathology. When considering only the major cardiovascular findings, the cardiologists' PEs still failed to correctly detect 43%. Point-of-care echocardiography reduced this to 21% wi thout significant interphysician variation. Conclusions Point-of-care echocardiography using a miniaturized echocardiog raphic platform substantially improved the detection of important cardiovas cular pathology compared with PE. Use of this device by a cardiovascular sp ecialist with training in echocardiography as a routine adjunct to PE appea rs to be useful. (J Am Cell Cardiol 2001;37:2013-8) (C) 2001 by the America n College of Cardiology.