The feasibility, diagnostic yield, and learning curve of portable echocardiography for out-of-hospital cardiovascular disease screening.
BACKGROUND
The reduction in the size of full-capability echocardiographic machines facilitates "out-of-hospital" transthoracic echocardiography (TTE). Data documenting the feasibility, yield, and logistical considerations of out-of-hospital TTE for preparticipation evaluation of athletes are sparse.


METHODS
A multiyear study was conducted to examine the role of 12-lead electrocardiography for athlete screening in which TTE was used to document or exclude underlying structural heart disease. Using a commercially available portable transthoracic echocardiographic system, the rate of technically adequate imaging, diagnostic yield, and the time required for the completion of TTE (including setup, performance, and interpretation) were examined. TTE was performed in university medical offices and at "out-of-office" athletic facilities. Measurements were recorded during each year of the study to determine the impact of targeted attempts to improve efficiency.


RESULTS
Four hundred sixty-seven of 510 participants had transthoracic echocardiographic images that were technically adequate for complete interpretation (imaging success rate, 92%). Echocardiographic evidence of physiologic, exercise-induced cardiac remodeling was observed in 110 of 510 (22%). Cardiac abnormalities with relevance to sports participation risk were detected in 11 of 508 participants (2.2%). Over 3 years, the average time for the completion of TTE (including setup, imaging, and interpretation) decreased (year 1, 17.4 ± 3 min; year 2, 14.0 ± 2.1 min; year 3, 11.0 ± 1.8 min; P < .001). This was driven by a significant decrease in the time required for TTE at out-of-office athletic facilities.


CONCLUSIONS
Community-based TTE in athletes is feasible and is associated with a high rate of technically adequate imaging. Importantly, there appears to be a significant learning curve associated with out-of-hospital TTE.
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. rweiner@partners.org
Rory B
RB
Weiner
Francis
F
Wang
Adolph M
AM
Hutter
Malissa J
MJ
Wood
Brant
B
Berkstresser
Carlene
C
McClanahan
Jennifer
J
Neary
Jane E
JE
Marshall
Michael H
MH
Picard
Aaron L
AL
Baggish
D056352:Athletes / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003153:Community Health Services / Q000706:statistics & numerical data; D004452:Echocardiography / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000295:instrumentation / Q000379:methods*; D019095:Point-of-Care Systems; D055815:Young Adult