title: The utility of pocket-sized echocardiography to assess left ventricular systolic function prior to permanent pacemaker implantation.
abstract: BACKGROUND
  A subset of patients receiving first-time permanent pacemakers (PPM) may also benefit from an implantable cardioverter defibrillator (ICD) based on the presence of left ventricular systolic dysfunction (LVSD). Routine screening using pocket-sized echocardiography (PSE) may be useful in identifying such patients.
  
  
  OBJECTIVE
  To determine whether PSE can be used by an inexperienced sonographer to adequately screen for LVSD in a patient population receiving a first-time PPM.
  
  
  METHODS
  A sonographic trainee (medical student) acquired images using PSE, which were then evaluated by an experienced echocardiologist for both image quality and presence of LVSD. The sensitivity and specificity of assessment by the inexperienced sonographer was compared to the level 3 echocardiologist.
  
  
  RESULTS
  The patient population included 71 individuals (66% male, mean age 77 ± 12 years). Interpretable images where left ventricular ejection fraction (LVEF) could be adequately assessed were obtained in 93% of the patient population. As compared with the echocardiologist, the sonographic trainee had a sensitivity of 60% and a specificity of 98% in detecting LVSD.
  
  
  CONCLUSIONS
  For patients receiving first-time PPM, the use of PSE by a sonographic trainee combined with interpretation by an experienced imaging cardiologist can triage for the need to perform standard transthoracic echocardiography (sTTE) by determining the presence of LVSD.
authors.affiliation: College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. umlau23@myumanitoba.ca.|Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. umlau23@myumanitoba.ca.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lau
authors.affiliation: College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. umducasr@cc.umanitoba.ca.|Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. umducasr@cc.umanitoba.ca.
authors.forename: Robin
authors.initials: R
authors.lastname: Ducas
authors.affiliation: College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. jacquesyr@yahoo.com.|Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. jacquesyr@yahoo.com.
authors.forename: Jacques
authors.initials: J
authors.lastname: Rizkallah
authors.affiliation: College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. djassal@sbgh.mb.ca.|Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. djassal@sbgh.mb.ca.
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Jassal
authors.affiliation: College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. cmseifer@sbgh.mb.ca.|Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. cmseifer@sbgh.mb.ca.|Section of Cardiology, Department of Internal Medicine and Associate Chief of Cardiology, Cardiac Sciences Program, Y3019 St Boniface Hospital, Winnipeg, MB, UK. cmseifer@sbgh.mb.ca.
authors.forename: Colette M
authors.initials: CM
authors.lastname: Seifer
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008904:Miniaturization; D010138:Pacemaker, Artificial; D018579:Patient Selection; D019095:Point-of-Care Systems; D011300:Preoperative Care; D019919:Prosthesis Implantation / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control