Hand carried echocardiography in the coronary care unit

Miniaturized echocardiography devices known as hand carried echocardiography (HCE) now exist with features similar to those used for standard echocardiography. The small size and low cost of these devices may lead to increased availability of echocardiography to be performed by all physicians taking care of critically ill patients. The objective of the investigation was to assess the value of limited HCE in the coronary care unit (CCU).

Material and methods: 88 patients were studied –54 men (61.4%) and 34 women (38.6%), mean age 64.75±1.31 years with acute coronary syndrome treated in the CCU. After admission patients underwent bedside limited HCE performed by specially trained during 60 hours CCU physicians. HCE included assessment of left ventricular (LV) wall motion abnormalities, LV function, absence or presence of LV aneurysm, LV thrombus and pericarditis. The same or next day experienced echocardiographer performed a comprehensive echo examination. So, we compared the results of bedside evaluation using HCE and comprehensive echocardiography.

Results: Sensitivity of limited HCE in revealing of LV wall motion abnormalities was 94.1%, LV aneurysm –37.5%, pericarditis –50%, LV thrombus –25%, in assessment of LV function was 55.5%; specificity of the method was 66.6%, 92.9%, 98.8%, 95.2%, 85%, respectively; negative predictive value was 28.5%, 86.8%, 98.8%, 96.4%, 93.4%, respectively; positive predictive value was 98.8%, 54.5%, 50%, 20%, 33.3%, respectively, and predictive accuracy was 93.2%, 81.8%, 97.7%, 92%, 70.4%, respectively.

Conclusions: Despite some limitations HCE can often answer important clinical questions in patients with acute coronary syndrome treated in CCU.