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.