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Tromp J, Sarra C, Nidhal B, Mejdi BM, Zouari F, Hummel Y, Mzoughi K, Kraiem S, Fehri W, Gamra H, Lam CSP, Mebazaa A, Addad F. Nurse-led home-based detection of cardiac dysfunction by ultrasound: results of the CUMIN pilot study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:163-169. [PMID: 38505488 PMCID: PMC10944680 DOI: 10.1093/ehjdh/ztad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 03/21/2024]
Abstract
Aims Access to echocardiography is a significant barrier to heart failure (HF) care in many low- and middle-income countries. In this study, we hypothesized that an artificial intelligence (AI)-enhanced point-of-care ultrasound (POCUS) device could enable the detection of cardiac dysfunction by nurses in Tunisia. Methods and results This CUMIN study was a prospective feasibility pilot assessing the diagnostic accuracy of home-based AI-POCUS for HF conducted by novice nurses compared with conventional clinic-based transthoracic echocardiography (TTE). Seven nurses underwent a one-day training program in AI-POCUS. A total of 94 patients without a previous HF diagnosis received home-based AI-POCUS, POC N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, and clinic-based TTE. The primary outcome was the sensitivity of AI-POCUS in detecting a left ventricular ejection fraction (LVEF) <50% or left atrial volume index (LAVI) >34 mL/m2, using clinic-based TTE as the reference. Out of seven nurses, five achieved a minimum standard to participate in the study. Out of the 94 patients (60% women, median age 67), 16 (17%) had an LVEF < 50% or LAVI > 34 mL/m2. AI-POCUS provided an interpretable LVEF in 75 (80%) patients and LAVI in 64 (68%). The only significant predictor of an interpretable LVEF or LAVI proportion was the nurse operator. The sensitivity for the primary outcome was 92% [95% confidence interval (CI): 62-99] for AI-POCUS compared with 87% (95% CI: 60-98) for NT-proBNP > 125 pg/mL, with AI-POCUS having a significantly higher area under the curve (P = 0.040). Conclusion The study demonstrated the feasibility of novice nurse-led home-based detection of cardiac dysfunction using AI-POCUS in HF patients, which could alleviate the burden on under-resourced healthcare systems.
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Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore & The National University Health System, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Chenik Sarra
- Military Hospital Tunis, Q5PH+896, Tunis, Tunisia
| | - Bouchahda Nidhal
- Fattouma Bourguiba University Hospital—Research Laboratory LR12SP16 and University of Monastir, QRCM+4GJ, Monastir, Tunisia
| | - Ben Messaoud Mejdi
- Fattouma Bourguiba University Hospital—Research Laboratory LR12SP16 and University of Monastir, QRCM+4GJ, Monastir, Tunisia
| | - Fourat Zouari
- Hannibal Clinic, Rue de la feuille d'Erable - les berges du lac 2, Tunis, Tunisia
| | - Yoran Hummel
- Us2.ai, 2 College Rd, #02-00, Singapore 169850, Singapore
| | - Khadija Mzoughi
- Faculty of Medicine of Tunis, Habib Thameur Hospital Tunis & University of Tunis El Manar, Q5PG+CJ7, Rue Ali Ben Ayed, Tunis, Tunisia
| | - Sondes Kraiem
- Faculty of Medicine of Tunis, Habib Thameur Hospital Tunis & University of Tunis El Manar, Q5PG+CJ7, Rue Ali Ben Ayed, Tunis, Tunisia
| | - Wafa Fehri
- Military Hospital Tunis, Q5PH+896, Tunis, Tunisia
| | - Habib Gamra
- Fattouma Bourguiba University Hospital—Research Laboratory LR12SP16 and University of Monastir, QRCM+4GJ, Monastir, Tunisia
| | - Carolyn S P Lam
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- National Heart Centre Singapore, 5 Hospital Dr, Singapore 169609, Singapore
| | - Alexandre Mebazaa
- Université Paris Cité, MASCOT Inserm Unit, 45 Rue des Saints-Pères, 75006 Paris, France
- Department of Anesthesia, Burn and Critical Care Medicine, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Faouzi Addad
- Hannibal Clinic, Rue de la feuille d'Erable - les berges du lac 2, Tunis, Tunisia
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Giangregorio F, Mosconi E, Debellis MG, Palermo E, Provini S, Mendozza M, Ricevuti L, Esposito C. Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The "Bed Med-Us" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients. Ultrasound Int Open 2024; 10:a21961599. [PMID: 38304447 PMCID: PMC10829908 DOI: 10.1055/a-2196-1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/22/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. Materials and Methods 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). Results HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. Conclusion BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.
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Jenkins S, Alabed S, Swift A, Marques G, Ryding A, Sawh C, Wardley J, Shah BN, Swoboda P, Senior R, Nijveldt R, Vassiliou VS, Garg P. Diagnostic accuracy of handheld cardiac ultrasound device for assessment of left ventricular structure and function: systematic review and meta-analysis. Heart 2021; 107:1826-1834. [PMID: 34362772 PMCID: PMC8562308 DOI: 10.1136/heartjnl-2021-319561] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Handheld 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. Methods MEDLINE 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. Results Thirty-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. Conclusion This 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 number CRD42020182429.
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Affiliation(s)
- Sam Jenkins
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Andrew Swift
- Cardiovascular and Metabolic Health, Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Gabriel Marques
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Alisdair Ryding
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Chris Sawh
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - James Wardley
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Benoy Nalin Shah
- Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | | | - Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Robin Nijveldt
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Pankaj Garg
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
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López Zúñiga MÁ, Vallejo Palomino T, Martin Toro MA, Castillo Fernández AM, Gerez Neira D, Vílchez Parras AM, Villa García MI, Martínez Colmenero J, Padilla Moreno F, Campos Calero A, Torres Macho J. Diagnostic Capacity of Pocket-Sized Ultrasound Devices at Point of Care by a Non-radiologist Resident in Patients with Suspected Abdominal Pathology. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:263-268. [PMID: 31767453 DOI: 10.1016/j.ultrasmedbio.2019.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Studies have reported the usefulness and tolerability in practice of abdominal ultrasound performed by non-radiologists in various clinical situations. This prospective observational single-center study included 184 patients hospitalized in an internal medicine department who underwent conventional abdominal ultrasound. A medical resident with basic training performed point-of-care clinical ultrasound using a pocket-sized device. The concordance obtained between the researcher and the radiologist was good (k >0.6) for the gallbladder, splenomegaly, longitudinal diameter of the kidney, presence of renal cysts and hydronephrosis. The specificity was >90% for all parameters assessed except normal renal size. A negative predictive value >90% was obtained for all variables studied except the presence of hepatic space-occupying lesions and gallbladder pathology, the negative predictive values for which were >80%. A positive predictive value >80% was obtained for all of these variables, except the presence of adenopathies, hepatomegaly, space-occupying lesions, echogenicity and/or enlargement of the biliary tract, left renal atrophy and right renal masses. We conclude there was a high concordance between a conventional abdominal study and that performed with a pocket-sized ultrasound device after a brief learning curve.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Juan Torres Macho
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
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Marbach JA, Almufleh A, Di Santo P, Jung R, Simard T, McInnes M, Salameh JP, McGrath TA, Millington SJ, Diemer G, West FM, Domecq MC, Hibbert B. Comparative Accuracy of Focused Cardiac Ultrasonography and Clinical Examination for Left Ventricular Dysfunction and Valvular Heart Disease: A Systematic Review and Meta-analysis. Ann Intern Med 2019; 171:264-272. [PMID: 31382273 DOI: 10.7326/m19-1337] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Incorporating focused cardiac ultrasonography (FoCUS) into clinical examination could improve the diagnostic yield of bedside patient evaluation. PURPOSE To compare the accuracy of FoCUS-assisted clinical assessment versus clinical assessment alone for diagnosing left ventricular dysfunction or valvular disease in adults having cardiovascular evaluation. DATA SOURCES English-language searches of MEDLINE, Embase, and Web of Science from 1 January 1990 to 23 May 2019 and review of reference citations. STUDY SELECTION Eligible studies were done in patients having cardiovascular evaluation; compared FoCUS-assisted clinical assessment versus clinical assessment alone for the diagnosis of left ventricular systolic dysfunction, aortic or mitral valve disease, or pericardial effusion; and used transthoracic echocardiography as the reference standard. DATA EXTRACTION Three study investigators independently abstracted data and assessed study quality. DATA SYNTHESIS Nine studies were included in the meta-analysis. The sensitivity of clinical assessment for diagnosing left ventricular dysfunction (left ventricular ejection fraction <50%) was 43% (95% CI, 33% to 54%), whereas that of FoCUS-assisted examination was 84% (CI, 74% to 91%). The specificity of clinical assessment was 81% (CI, 65% to 90%), and that of FoCUS-assisted examination was 89% (CI, 85% to 91%). The sensitivities of clinical assessment and FoCUS-assisted examination for diagnosing aortic or mitral valve disease (of at least moderate severity) were 46% (CI, 35% to 58%) and 71% (CI, 63% to 79%), respectively. Both the clinical assessment and the FoCUS-assisted examination had a specificity of 94% (CI, 91% to 96%). LIMITATION Evidence was scant, persons doing ultrasonography had variable skill levels, and most studies had unclear or high risk of bias. CONCLUSION Clinical examination assisted by FoCUS has greater sensitivity, but not greater specificity, than clinical assessment alone for identifying left ventricular dysfunction and aortic or mitral valve disease; FoCUS-assisted examination may help rule out cardiovascular pathology in some patients, but it may not be sufficient for definitive confirmation of cardiovascular disease suspected on physical examination. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42019124318).
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Affiliation(s)
- Jeffrey A Marbach
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada (J.A.M., R.J., T.S.)
| | - Aws Almufleh
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada, and King Saud University, Riyadh, Saudi Arabia (A.A.)
| | - Pietro Di Santo
- University of Ottawa Heart Institute and University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada (P.D., M.M., J.S.)
| | - Richard Jung
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada (J.A.M., R.J., T.S.)
| | - Trevor Simard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada (J.A.M., R.J., T.S.)
| | - Matthew McInnes
- University of Ottawa Heart Institute and University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada (P.D., M.M., J.S.)
| | - Jean-Paul Salameh
- University of Ottawa Heart Institute and University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada (P.D., M.M., J.S.)
| | - Trevor A McGrath
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada (T.A.M., S.J.M.)
| | - Scott J Millington
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada (T.A.M., S.J.M.)
| | - Gretchen Diemer
- Thomas Jefferson University, Philadelphia, Pennsylvania (G.D., F.M.W.)
| | - Frances Mae West
- Thomas Jefferson University, Philadelphia, Pennsylvania (G.D., F.M.W.)
| | - Marie-Cecile Domecq
- University of Ottawa Health Sciences Library, Ottawa, Ontario, Canada (M.D.)
| | - Benjamin Hibbert
- University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada (B.H.)
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López Zúñiga MÁ, Martín Toro MA, Vallejo Palomino T, Castillo Fernández AM, Campos Calero Á, Vílchez Parras AM, Villa García MI, Gerez Neira DV, Martinez Colmenero J, Padilla Moreno F. Accuracy of cardiac ultrasound performed by a noncardiologist resident. Med Clin (Barc) 2019; 153:43-44. [PMID: 30470446 DOI: 10.1016/j.medcli.2018.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/28/2022]
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Pérez de Isla L, Díaz Sánchez S, Pagola J, García de Casasola Sánchez G, López Fernández T, Sánchez Barrancos IM, Martínez-Sánchez P, Zapatero Gaviria A, Anguita M, Ruiz Serrano AL, Torres Macho J. Documento de consenso de SEMI, semFYC, SEN y SEC sobre ecocardioscopia en España. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Pérez de Isla L, Díaz Sánchez S, Pagola J, García de Casasola Sánchez G, López Fernández T, Sánchez Barrancos IM, Martínez-Sánchez P, Zapatero Gaviria A, Anguita M, Ruiz Serrano AL, Torres Macho J. Consensus Document of the SEMI, semFYC, SEN, and SEC on Focused Cardiac Ultrasound in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:935-940. [PMID: 30119954 DOI: 10.1016/j.rec.2018.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
This document summarizes the concept of focused cardiac ultrasound, the basic technical aspects related to this technique, and its diagnostic objectives. It also defines training requisites in focused cardiac ultrasound. This consensus document has been endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Neurology (SEN), and the Spanish Society of Cardiology (SEC).
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Affiliation(s)
| | | | - Jorge Pagola
- Servicio de Neurología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | | | - Juan Torres Macho
- Servicio de Medicina Interna-Urgencias, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
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Presente y futuro de la ecografía clínica en medicina interna: una expansión inevitable. Rev Clin Esp 2016; 216:421-422. [DOI: 10.1016/j.rce.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/23/2016] [Indexed: 11/20/2022]
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Blanco P. Physical examination along with point-of-care echocardiography: an indisputable right path. Am J Emerg Med 2016; 34:673. [PMID: 26847157 DOI: 10.1016/j.ajem.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Pablo Blanco
- Intensive care unit, Hospital "Dr. Emilio Ferreyra", Necochea 7630, Argentina.
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