title: Hand-carried ultrasound performed at bedside in cardiology inpatient setting - a comparative study with comprehensive echocardiography.
abstract: BACKGROUND
  Hand-carried ultrasound (HCU) devices have been demonstrated to improve the diagnosis of cardiac diseases over physical examination, and have the potential to broaden the versatility in ultrasound application. The role of these devices in the assessment of hospitalized patients is not completely established. In this study we sought to perform a direct comparison between bedside evaluation using HCU and comprehensive echocardiography (CE), in cardiology inpatient setting.
  
  
  METHODS
  We studied 44 consecutive patients (mean age 54 +/- 18 years, 25 men) who underwent bedside echocardiography using HCU and CE. HCU was performed by a cardiologist with level-2 training in the performance and interpretation of echocardiography, using two-dimensional imaging, color Doppler, and simple calliper measurements. CE was performed by an experienced echocardiographer (level-3 training) and considered as the gold standard.
  
  
  RESULTS
  There were no significant differences in cardiac chamber dimensions and left ventricular ejection fraction determined by the two techniques. The agreement between HCU and CE for the detection of segmental wall motion abnormalities was 83% (Kappa = 0.58). There was good agreement for detecting significant mitral valve regurgitation (Kappa = 0.85), aortic regurgitation (kappa = 0.89), and tricuspid regurgitation (Kappa = 0.74). A complete evaluation of patients with stenotic and prosthetic dysfunctional valves, as well as pulmonary hypertension, was not possible using HCU due to its technical limitations in determining hemodynamic parameters.
  
  
  CONCLUSIONS
  Bedside evaluation using HCU is helpful for assessing cardiac chamber dimensions, left ventricular global and segmental function, and significant valvular regurgitation. However, it has limitations regarding hemodynamic assessment, an important issue in the cardiology inpatient setting.
authors.affiliation: Echocardiography Laboratory of the Heart Institute (InCor) - University of Sao Paulo Medical School, Sao Paulo, Brazil. jeanetsutsui@msn.com
authors.forename: Jeane M
authors.initials: JM
authors.lastname: Tsutsui
authors.forename: Raquel R
authors.initials: RR
authors.lastname: Maciel
authors.forename: Joicely M
authors.initials: JM
authors.lastname: Costa
authors.forename: Jose L
authors.initials: JL
authors.lastname: Andrade
authors.forename: Jose F
authors.initials: JF
authors.lastname: Ramires
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
mesh_terms: D002309:Cardiology / Q000295:instrumentation / Q000379:methods; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods; D015150:Echocardiography, Doppler / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D015588:Observer Variation; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*