Point-of-care screening for left ventricular hypertrophy and concentric geometry using hand-held cardiac ultrasound in hypertensive patients.

BACKGROUND: The introduction of the hand-held cardiac ultrasound (HCU) may potentially increase detection of LV hypertrophy in hypertensive patients. However, whether point-of-care screening for LV hypertrophy and concentric LV geometry by HCU in hypertensive patients is feasible and comparable to that of standard state-of-the-art echocardiography (SE) evaluation remains to be elucidated. METHODS AND
RESULTS: Accordingly, one hundred consecutive patients (66 female, mean age=58±13 years, 32% African-American, mean body mass index=31±8 kg/m(2)) with the diagnosis of hypertension underwent both HCU and SE examinations in tandem. A cardiology fellow-in-training performed the HCU exam while a cardiac sonographer performed the SE. 37% of hypertensive patients had electrocardiographic LV hypertrophy by Sokolow-Lyon or Cornell voltage criteria. Mean LV mass was 210±42 g with the HCU and 209±40 g with SE. Mean relative wall thickness was 0.45±0.05 by the HCUD and 0.44±0.05 by SE. There was excellent correlation between LV mass and relative wall thickness measurements by HCU and SE (r=0.985, SEE=6.8 g and r=0.762, SEE=0.33, respectively, both p<0.001). The prevalence of LV hypertrophy using prognostically-validated partition values for LV mass/height(2.7) of 46.7 and 49.2 g/m(2.7) in women and men, respectively was 76% by HCU and 78% by SE (p=NS), with excellent agreement (92%, κ=0.774, p<0.001). Agreement for detection of concentric LV geometry (relative wall thickness>0.43) was also excellent (88%, κ =0.756, p<0.001). Agreement for LV hypertrophy and concentric geometry detection between the cardiology fellow-in-training and sonographer was excellent (κ =0.786, p<0.001).
CONCLUSION: Point-of-care screening for LV hypertrophy and concentric LV geometry by HCU is feasible and correlates very well with that of SE. HCU may allow for immediate point-of-care assessment and treatment of cardiac target organ damage in hypertensive patients.