Background

The authors assessed the performance of pocket-sized transthoracic echocardiography (pTTE) compared with standard transthoracic echocardiography (sTTE) and auscultation for early screening of valvular heart disease (VHD). Early diagnosis of significant VHD is a challenge, but it enables appropriate follow-up and implementation of the best therapeutic strategy.

Methods

sTTE, pTTE, and auscultation were performed by three different experienced physicians on 284 unselected patients. All cases of VHD detected by each of these three techniques were noted. sTTE was the gold standard. Each physician performed one examination and was blinded to the results of other examinations.

Results

We diagnosed a total of 301 cases of VHD, with a large predominance of regurgitant lesions: 269 cases (89.3%) of regurgitant VHD and 32 (10.7%) of stenotic VHD. pTTE was highly sensitive (85.7%) and specific (97.9%) for screening for VHD, while auscultation detected only 54.1%. All significant cases of VHD (at least mild severity) were detected on pTTE. The weighted κ coefficient between pTTE and sTTE for the assessment of mitral regurgitation was 0.71 (95% CI, 0.70–0.72), indicating good agreement. The weighted κ coefficients between pTTE and sTTE for the assessment of aortic regurgitation and aortic stenosis were 0.97 (95% CI, 0.96–0.98) and 0.98 (95% CI, 0.97–0.99), respectively, indicating excellent agreement.

Conclusions

pTTE performed by physicians with level III competency in echocardiography is reliable for identifying significant VHD and should be proposed as a new screening tool.

中文翻译：

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使用袖珍型经胸超声心动图设备筛查天然瓣膜性心脏病

背景

作者评估了袖珍型经胸超声心动图 (pTTE) 与标准经胸超声心动图 (sTTE) 和听诊在瓣膜性心脏病 (VHD) 早期筛查中的表现。显着 VHD 的早期诊断是一项挑战，但它能够进行适当的随访和实施最佳治疗策略。

方法

sTTE、pTTE 和听诊由三位不同的经验丰富的医生对 284 名未选择的患者进行。记录了通过这三种技术中的每一种检测到的所有 VHD 病例。sTTE 是黄金标准。每位医生都进行了一次检查，而对其他检查的结果视而不见。

结果

我们共诊断出 301 例 VHD，其中以反流性病变为主：反流性 VHD 269 例（89.3%），狭窄性 VHD 32 例（10.7%）。pTTE 对 VHD 筛查具有高度敏感性 (85.7%) 和特异性 (97.9%)，而听诊仅检测到 54.1%。在 pTTE 上检测到所有重要的 VHD 病例（至少轻度严重）。用于评估二尖瓣关闭不全的 pTTE 和 sTTE 之间的加权 κ 系数为 0.71（95% CI，0.70-0.72），表明一致性良好。用于评估主动脉瓣关闭不全和主动脉瓣狭窄的 pTTE 和 sTTE 之间的加权 κ 系数分别为 0.97（95% CI，0.96-0.98）和 0.98（95% CI，0.97-0.99），表明一致性非常好。

结论

由具有 III 级超声心动图能力的医师进行的 pTTE 对识别显着的 VHD 是可靠的，应该被提议作为一种新的筛查工具。