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Comparative Study
. 2013 Oct;36(10):603-10.
doi: 10.1002/clc.22171. Epub 2013 Jul 24.

Diagnostic Accuracy and Cost-Effectiveness of a Pocket-Sized Transthoracic Echocardiographic Imaging Device

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Free PMC article
Comparative Study

Diagnostic Accuracy and Cost-Effectiveness of a Pocket-Sized Transthoracic Echocardiographic Imaging Device

Ryoko Kitada et al. Clin Cardiol. .
Free PMC article

Abstract

Background: The recently introduced pocket-sized portable transthoracic echocardiography (pTTE) is accurate for measurement of cardiac chamber size and function as well as for assessment of valvular regurgitation. This study aimed to compare the diagnostic accuracy of the pocket-sized pTTE with the standard TTE (sTTE) and assess its cost-effectiveness.

Hypothesis: The use of pocket-sized pTTE, as an initial screening tool, may be feasible, accurate and cost-effective in the diagnostic strategy of cardiac abnormalities.

Methods: The study subjects were 200 patients scheduled for sTTE and an electrocardiogram (ECG). Each patient underwent pTTE examination with the Vscan (GE Medical Systems, Milwaukee, WI) immediately after sTTE. The findings of pTTE and the ECG were compared with the results of sTTE. Cost-effectiveness was calculated.

Results: There was a strong agreement in the detection of abnormal findings between pTTE and sTTE (agreement = 90%), whereas the agreement between the ECG and sTTE was 65%. When pTTE or the ECG was used as an initial screening tool prior to sTTE, similar cost reduction was obtained (approximately 30%) by reducing the number of referrals for sTTE. However, the negative predictive value of a diagnostic strategy with pTTE (92%) was superior to that with an ECG (67%).

Conclusions: This study demonstrates that the pocket-sized pTTE provides accurate detection of cardiac structural and functional abnormalities beyond the ECG. In addition, the use of pTTE as an initial screening tool prior to sTTE is cost-effective, suggesting that the pocket-sized pTTE is poised to alter the current diagnostic strategy in clinical practice.

Figures

Figure 1
Figure 1
Agreement between standard transthoracic echocardiography (TTE) and portable TTE (upper row), and electrocardiogram (ECG) (lower row) in the detection of patients with abnormal echocardiography overall (A), in the low‐risk group (B), and the high‐risk group (C), respectively. Abbreviations: NPV, negative predictive value; PPV, positive predictive value.
Figure 2
Figure 2
Different diagnostic strategies. Strategy 1: All patients had standard transthoracic echocardiography (sTTE) examination without prior electrocardiogram (ECG) and portable transthoracic echocardiography (pTTE) screening. Strategy 2: An ECG was obtained in all patients as an initial screening test, and sTTE was performed in patients with an abnormal ECG. Strategy 3: pTTE was used as an initial screening test instead of an ECG, and patients with abnormal pTTE were referred for sTTE. Strategy 4: Patients with an abnormal ECG had sTTE, but patients with a normal ECG had pTTE. The indication of sTTE depended on pTTE findings. Strategy 5: High‐risk patients had sTTE without any screening test. Low‐risk patients had an ECG, and patients with an abnormal ECG were referred for sTTE. Strategy 6: Similar to strategy 5, screening was performed only in low‐risk patients, but pTTE was used instead of an ECG. Strategy 7: pTTE was performed prior to sTTE in high‐risk patients. In low‐risk patients, only patients with abnormal results of an ECG and pTTE were referred for sTTE.

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