Jeffrey A Marbach1, Aws Almufleh2, Pietro Di Santo3, Richard Jung1, Trevor Simard1, Matthew McInnes3, Jean-Paul Salameh3, Trevor A McGrath4, Scott J Millington4, Gretchen Diemer5, Frances Mae West5, Marie-Cecile Domecq6, Benjamin Hibbert7. 1. University of Ottawa Heart Institute, Ottawa, Ontario, Canada (J.A.M., R.J., T.S.). 2. University of Ottawa Heart Institute, Ottawa, Ontario, Canada, and King Saud University, Riyadh, Saudi Arabia (A.A.). 3. University of Ottawa Heart Institute and University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada (P.D., M.M., J.S.). 4. University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada (T.A.M., S.J.M.). 5. Thomas Jefferson University, Philadelphia, Pennsylvania (G.D., F.M.W.). 6. University of Ottawa Health Sciences Library, Ottawa, Ontario, Canada (M.D.). 7. University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada (B.H.).
Abstract
Background: Incorporating focused cardiac ultrasonography (FoCUS) into clinical examination could improve the diagnostic yield of bedside patient evaluation. Purpose: To compare the accuracy of FoCUS-assisted clinical assessment versus clinical assessment alone for diagnosing left ventricular dysfunction or valvular disease in adults having cardiovascular evaluation. Data Sources: English-language searches of MEDLINE, Embase, and Web of Science from 1 January 1990 to 23 May 2019 and review of reference citations. Study Selection: Eligible studies were done in patients having cardiovascular evaluation; compared FoCUS-assisted clinical assessment versus clinical assessment alone for the diagnosis of left ventricular systolic dysfunction, aortic or mitral valve disease, or pericardial effusion; and used transthoracic echocardiography as the reference standard. Data Extraction: Three study investigators independently abstracted data and assessed study quality. Data Synthesis: Nine studies were included in the meta-analysis. The sensitivity of clinical assessment for diagnosing left ventricular dysfunction (left ventricular ejection fraction <50%) was 43% (95% CI, 33% to 54%), whereas that of FoCUS-assisted examination was 84% (CI, 74% to 91%). The specificity of clinical assessment was 81% (CI, 65% to 90%), and that of FoCUS-assisted examination was 89% (CI, 85% to 91%). The sensitivities of clinical assessment and FoCUS-assisted examination for diagnosing aortic or mitral valve disease (of at least moderate severity) were 46% (CI, 35% to 58%) and 71% (CI, 63% to 79%), respectively. Both the clinical assessment and the FoCUS-assisted examination had a specificity of 94% (CI, 91% to 96%). Limitation: Evidence was scant, persons doing ultrasonography had variable skill levels, and most studies had unclear or high risk of bias. Conclusion: Clinical examination assisted by FoCUS has greater sensitivity, but not greater specificity, than clinical assessment alone for identifying left ventricular dysfunction and aortic or mitral valve disease; FoCUS-assisted examination may help rule out cardiovascular pathology in some patients, but it may not be sufficient for definitive confirmation of cardiovascular disease suspected on physical examination. Primary Funding Source: None. (PROSPERO: CRD42019124318).
Background: Incorporating focused cardiac ultrasonography (FoCUS) into clinical examination could improve the diagnostic yield of bedside patient evaluation. Purpose: To compare the accuracy of FoCUS-assisted clinical assessment versus clinical assessment alone for diagnosing left ventricular dysfunction or valvular disease in adults having cardiovascular evaluation. Data Sources: English-language searches of MEDLINE, Embase, and Web of Science from 1 January 1990 to 23 May 2019 and review of reference citations. Study Selection: Eligible studies were done in patients having cardiovascular evaluation; compared FoCUS-assisted clinical assessment versus clinical assessment alone for the diagnosis of left ventricular systolic dysfunction, aortic or mitral valve disease, or pericardial effusion; and used transthoracic echocardiography as the reference standard. Data Extraction: Three study investigators independently abstracted data and assessed study quality. Data Synthesis: Nine studies were included in the meta-analysis. The sensitivity of clinical assessment for diagnosing left ventricular dysfunction (left ventricular ejection fraction <50%) was 43% (95% CI, 33% to 54%), whereas that of FoCUS-assisted examination was 84% (CI, 74% to 91%). The specificity of clinical assessment was 81% (CI, 65% to 90%), and that of FoCUS-assisted examination was 89% (CI, 85% to 91%). The sensitivities of clinical assessment and FoCUS-assisted examination for diagnosing aortic or mitral valve disease (of at least moderate severity) were 46% (CI, 35% to 58%) and 71% (CI, 63% to 79%), respectively. Both the clinical assessment and the FoCUS-assisted examination had a specificity of 94% (CI, 91% to 96%). Limitation: Evidence was scant, persons doing ultrasonography had variable skill levels, and most studies had unclear or high risk of bias. Conclusion: Clinical examination assisted by FoCUS has greater sensitivity, but not greater specificity, than clinical assessment alone for identifying left ventricular dysfunction and aortic or mitral valve disease; FoCUS-assisted examination may help rule out cardiovascular pathology in some patients, but it may not be sufficient for definitive confirmation of cardiovascular disease suspected on physical examination. Primary Funding Source: None. (PROSPERO: CRD42019124318).
Authors: Michael Ke Wang; Joshua Piticaru; Coralea Kappel; Michael Mikhaeil; Lawrence Mbuagbaw; Bram Rochwerg Journal: Intern Emerg Med Date: 2022-06-20 Impact factor: 5.472
Authors: Isabella Morais Martins Barros; Marcio Vinicius L Barros; Larissa Natany Almeida Martins; Antonio Luiz P Ribeiro; Raul Silva Simões de Camargo; Claudia Di Lorenzo Oliveira; Ariela Mota Ferreira; Lea Campos de Oliveira; Ana Luiza Bierrenbach; Desireé Sant Ana Haikal; Ester Cerdeira Sabino; Clareci S Cardoso; Maria Carmo Pereira Nunes Journal: PLoS One Date: 2021-11-04 Impact factor: 3.752
Authors: Serafín López Palmero; Miguel Angel López Zúñiga; Virginia Rodríguez Martínez; Raul Reyes Parrilla; Ana Maria Alguacil Muñoz; Waldo Sánchez-Yebra Romera; Patricia Martín Rico; Inmaculada Poquet Catalá; Carlos Jiménez Guardiola; Alfonso Del Pozo Pérez; Ruben Lobato Cano; Ana Maria Lazo Torres; Gines López Martínez; Luis Felipe Díez García; Tesifon Parrón Carreño Journal: J Clin Med Date: 2022-06-23 Impact factor: 4.964