Accuracy of left ventricular ejection fraction determined by automated analysis of handheld echocardiograms: A comparison of experienced and novice examiners

Echocardiography. 2019 Dec;36(12):2145-2151. doi: 10.1111/echo.14546. Epub 2019 Dec 1.


Background: Handheld ultrasound devices have been developed that facilitate imaging in new clinical settings. However, quantitative assessment has been difficult. Software algorithms have recently been developed with the aim of providing rapid measurements of left ventricular ejection fraction (LVEF) with minimal operator input.

Methods: We prospectively enrolled a cohort of 70 patients scheduled to undergo echocardiography at the University of California, San Diego. Each patient underwent a standard echocardiography examination by an experienced sonographer as well as a handheld ultrasound with automated software by both the sonographer and an inexperienced resident.

Results: There was a positive correlation between the LVEFs obtained from the standard transthoracic echocardiogram and handheld device in the hands of a novice (r = 0.62; 95% CI 0.45-0.75) and experienced sonographer (r = 0.69; 95% CI 0.54-0.80). The sensitivity and specificity to detect a reduced LVEF (<50%) were 69% and 96% for the novice and 64% and 98% for the experienced sonographer. The sensitivity and specificity to detect a severely reduced LVEF (<35%) were 67% and 97% for the novice and 56% and 93% for the experienced sonographer, but when limited to recordings of at least adequate quality, improved to 100% and 100% for the novice and 100% and 98% for the experienced sonographer, respectively.

Conclusion: These data demonstrate that the handheld ultrasound device paired with novel software can provide a clinically useful estimate of LVEF when the images are of adequate quality and yield results by novice examiners that are similar to experienced sonographers.

Keywords: diagnostic imaging tools; echocardiography; hand-carried ultrasound; heart failure; left ventricular ejection fraction.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms*
  • Computers, Handheld*
  • Echocardiography, Three-Dimensional / methods*
  • Female
  • Follow-Up Studies
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Reproducibility of Results
  • Stroke Volume / physiology*
  • Ventricular Dysfunction, Left / diagnosis*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left / physiology*