Introduction
As ultrasound technology becomes more readily accessible, the use of
hand-held devices (HHU) is becoming increasingly prevalent in assessing
most organ systems. In the high-stakes and time-sensitive field of
cardiology, point of care ultrasound has been shown to be a valuable
tool for evaluating cardiovascular status (1-3). Examples include
revealing the presence of reversible causes of cardiovascular compromise
(including cardiac tamponade, hypovolemia, myocardial infarction, and
pulmonary embolism), as well as estimating left ventricular ejection
fraction (LVEF) and cardiac wall motion abnormalities (4-6). These
findings may play crucial roles in the clinical decision-making process
in regards to whether or not a patient should be sent to the
catheterization laboratory as well as in the discernment of the etiology
of the acute myocardial injury (AMI). The information acquired through
the use of HHU has been shown to change patient management in acute
settings (7-9) by helping to direct the clinicians towards a diagnosis,
such that focused ultrasound has become an important part of the
evaluation of patients undergoing AMI workup (10).
The need to rapidly diagnose and triage AMI patients makes the use of
HHU appealing, particularly in patients with an equivocal diagnosis and
treatment options. In these patients, the ability to estimate LVEF and
identify wall motion abnormalities can often change the course of
patient’s management and this is the area in which a rapid bedside HHU
(as opposed to standard TTE, which may not be readily available) can
prove to be of significant utility. As a result, it is important to
determine the reliability of the information acquired by HHU and its
agreement with the gold standard TTE, as well as the possible ways in
which HHU can affect care in patients presenting with suspected AMI.
As the first responders to AMI activations, the quality of images
acquired by cardiology fellows and their confidence in the
interpretation of HHU studies are important factors in determining the
reliability and precision of the study results and in subsequent rapid
identification of cases that need urgent interventions. Furthermore,
despite the proven benefits of HHU, adoption of this tool has remained
heterogeneous and sporadic among both academic and community centers
alike. In this study we hypothesized that HHU, when performed and
interpreted by trained cardiology fellows, provides accurate diagnostic
capabilities compared with standard TTE in patients with AMI and could
lead to changes in clinical management and improvement in treatment
workflows.