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Kardiyak Konsültasyonlar Esnasında Tanı ve Tedavide Taşınabilir Ekokardiyografi Cihazları ile Birlikte Fizik Muayenenin Karşılaştırılması

Year 2016, Volume: 19 Issue: 1, 23 - 26, 04.04.2016

Abstract











Giriş:
Bu çalışmanın amacı, kardiyak konsültasyon
esnasında tanı ve tedavi üzerinde ekokardiyografi sonuçları ile kardiyolog
tarafından gerçekleştirilen fizik muayene sonuçlarını karşılaştırmaktır.



Hastalar
ve Yöntem:
Kardiyak olmayan birimlerden
yatırılan ardışık seçilmemiş 265 hasta danışman kardiyolog tarafından tam
kardiyovasküler muayene sonrası çalışmaya alındı. Fizik muayene sonrası
danışman kardiyolog taşınabilir kardiyak ultrason kullanarak her hastayı
görüntülenmiştir. Tüm hastalar daha sonra bir üst platformda gerçekleştirilen
standart ekokardiyografik cihazla altın standart olarak değerlendirildi. Kesin
tanı, tedavi ve tanısal testlerdeki değişiklikler değerlendirildi.



Bulgular:
Bu hasta popülasyonunda standart ekokardiyografik
cihazla 196 kardiyovasküler bulgu saptanmıştır. Fizik muayene tüm bulguların
%41’ini ve taşınabilir ultrason ise %23’ünü tespit etmede başarısız olmuştur.
Taşınabilir kardiyak ultrason cihazı 149 hastanın tedavi kararında etkili
olmuştur ve bunların %42’sinde tedavi değişirken %21’inde tanısal testler
değişmiştir (hastaların çoğunda ikisi de değişmiştir).



Sonuç: Konsültasyonlar esnasında taşınabilir
kardiyak ultrason ile değerlendirme önemli kardiyovasküler patolojilerin
tespitini sağlamaktadır. Ayrıca, rutin fizik muayeneye ek olarak deneyimli
kardiyologlar tarafından taşınabilir cihazla yatak başı kardiyak fonksiyon ve
anatominin direkt değerlendirilmesi tedavi ve tanısal testlerde önemli
değişiklikler ile sonuçlanmaktadır.

References

  • 1. Reich DL, Bodian CA, Krol M, Kuroda M, Osinski T, Thys DM. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg 1999;89:814-22.
  • 2. Mangione S, Nieman LZ. Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency. JAMA 1997;278:717-22.
  • 3. St Clair EW, Oddone EZ, Waugh RA, Corey GR, Feussner JR. Assessing housestaff diagnostic skills using a cardiology patient simulator. Ann Intern Med 1992;117:751-6.
  • 4. Fukuda S, Shimada K, Kawasaki T. Pocketsized transthoracic echocardiography device for the measurement of cardiac chamber size and function. Circ J 2009;73:1092-6.
  • 5. Egan M, Ionescu A. The pocket echocardiograph: a useful new tool. Eur J Echocardiogr 2008;9:721-5.
  • 6. Prinz C, Dohrmann J, van Buuren F. Diagnostic performance of handheld echocardiography for the assessment of basic cardiac morphology and function: a validation study in routine cardiac patients. Echocardiography 2012;29:887-94.
  • 7. Vourvouri EC, Poldermans D, De Sutter J, Sozzi FB, Izzo P, Roelandt JR. Experience with an ultrasound stethoscope. J Am Soc Echocardiogr 2002;15:80-5.
  • 8. Spencer KT, Anderson AS, Bhargava A. Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient. J Am Coll Cardiol 2001;37:2013-8.
  • 9. Prinz C, Voigt JU. Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr 2011;24:111-6.
  • 10. Culp BC, Mock JD, Ball TR, Chiles CD, Culp WD. The pocket echocardiograph: a pilot study of its validation and feasibility in intubated patients. Echocardiography 2011;28:371-7.
  • 11. Nguyen VT, Ho JE, Ho CY, Givertz MM, Stevenson LW. Handheld echocardiography offers rapid assessment of clinical volume status. Am Heart J 2008;156:537-42.
  • 12. Rugolotto M, Chang CP, Hu B, Schnittger I, Liang DH. Clinical use of cardiac ultrasound performed with a hand-carried device in patients admitted for acute cardiac care. Am J Cardiol 2002;90:1040-2.

Comparison of Ultraportable Cardiac Echocardiography with Physical Examination for Diagnosis and Management during Cardiac Consultation Rounds

Year 2016, Volume: 19 Issue: 1, 23 - 26, 04.04.2016

Abstract











Introduction:
The purpose of this study was to compare the
results of physical examinations (PEs) performed by a cardiologist with the
results of point-of-care echocardiography for the diagnosis and management of
patients during cardiac consultation rounds.



Patients
and Methods:
In all, 265 hospitalized consecutive patients
from non-cardiac units (age, 62 ± 11; male, 56%) were included after complete
cardiovascular (CV) examination by a consulting cardiologist. After the PE, the
consulting cardiologist imaged each patient using a hand-carried cardiac
ultrasound (HCU). All patients subsequently underwent a study with a standard
echocardiographic device (SED) as the gold standard, performed on an upper-end
platform. Definitive diagnosis, management change, and modifying diagnostic
workup were also assessed.



Results:
There were 196 CV findings detected with an SED in
this patient population. Of these, PE failed to detect 41% of the overall CV
findings and HCU missed 23% of the overall CV pathology. Overall, HCU had an
effect on patient treatment decisions in 149 patients (56%); 42% had a change
in medical therapy and 21% had a change in their diagnostic workup (most with
changes in both).



Conclusion: HCU echocardiographic
assessment during consultation rounds improved the detection of significant CV
pathology. Also, a direct assessment of cardiac function and anatomy at the
bedside by an experienced cardiologist with HCU as a routine adjunct to PE
results in an important change in clinical management and diagnostic workup
during consultation.

References

  • 1. Reich DL, Bodian CA, Krol M, Kuroda M, Osinski T, Thys DM. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg 1999;89:814-22.
  • 2. Mangione S, Nieman LZ. Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency. JAMA 1997;278:717-22.
  • 3. St Clair EW, Oddone EZ, Waugh RA, Corey GR, Feussner JR. Assessing housestaff diagnostic skills using a cardiology patient simulator. Ann Intern Med 1992;117:751-6.
  • 4. Fukuda S, Shimada K, Kawasaki T. Pocketsized transthoracic echocardiography device for the measurement of cardiac chamber size and function. Circ J 2009;73:1092-6.
  • 5. Egan M, Ionescu A. The pocket echocardiograph: a useful new tool. Eur J Echocardiogr 2008;9:721-5.
  • 6. Prinz C, Dohrmann J, van Buuren F. Diagnostic performance of handheld echocardiography for the assessment of basic cardiac morphology and function: a validation study in routine cardiac patients. Echocardiography 2012;29:887-94.
  • 7. Vourvouri EC, Poldermans D, De Sutter J, Sozzi FB, Izzo P, Roelandt JR. Experience with an ultrasound stethoscope. J Am Soc Echocardiogr 2002;15:80-5.
  • 8. Spencer KT, Anderson AS, Bhargava A. Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient. J Am Coll Cardiol 2001;37:2013-8.
  • 9. Prinz C, Voigt JU. Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr 2011;24:111-6.
  • 10. Culp BC, Mock JD, Ball TR, Chiles CD, Culp WD. The pocket echocardiograph: a pilot study of its validation and feasibility in intubated patients. Echocardiography 2011;28:371-7.
  • 11. Nguyen VT, Ho JE, Ho CY, Givertz MM, Stevenson LW. Handheld echocardiography offers rapid assessment of clinical volume status. Am Heart J 2008;156:537-42.
  • 12. Rugolotto M, Chang CP, Hu B, Schnittger I, Liang DH. Clinical use of cardiac ultrasound performed with a hand-carried device in patients admitted for acute cardiac care. Am J Cardiol 2002;90:1040-2.
There are 12 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Mehmet Ali Astarcıoğlu

Taner Şen This is me

Celal Kilit This is me

Halil İbrahim Durmuş This is me

Adnan Doğan This is me

Türkan Paşalı Kilit This is me

Afşin Parspur This is me

Mehmet Yaymacı This is me

Muhammed Oylumlu This is me

Publication Date April 4, 2016
Published in Issue Year 2016 Volume: 19 Issue: 1

Cite

Vancouver Astarcıoğlu MA, Şen T, Kilit C, Durmuş Hİ, Doğan A, Paşalı Kilit T, Parspur A, Yaymacı M, Oylumlu M. Comparison of Ultraportable Cardiac Echocardiography with Physical Examination for Diagnosis and Management during Cardiac Consultation Rounds. Koşuyolu Heart Journal. 2016;19(1):23-6.