Pediatric Cardiology

, Volume 40, Issue 1, pp 154–160 | Cite as

Real-World Evaluation of the Eko Electronic Teleauscultation System

  • Shashank Behere
  • Jeanne Marie Baffa
  • Scott Penfil
  • Nicholas SlamonEmail author
Original Article


Heart murmur evaluation is the most common cause of referral to cardiology, and auscultation of heart sounds with a stethoscope remains a key component of the initial cardiovascular exam. Adoption of telecardiology has been limited by challenges in teleauscultation. We set out to compare in-person auscultatory findings with heart sounds recorded by the Core stethoscope (Eko, Berkeley, CA) in patients with normal heart sounds, innocent heart murmurs, and a variety of pathologic findings. Our study demonstrates that Eko recordings had a high percent of agreement with in-person auscultation findings and echocardiogram findings, with moderate inter-rater reliability. It was useful in identifying patients with pathologic murmurs who would benefit from further assessment. It was able to discern major types of pathological murmurs. Certain qualitative differences in the recorded sounds as compared to in-person auscultation were identified by the reading cardiologists. They were able to acclimate to these subtle differences. The system was felt to be easy to use, and most cardiologists in the study would consider using it in clinical settings. The Eko Core system may be a useful screening tool for murmur evaluation.


Teleauscultation Telecardiology Electronic stethoscope Eko 



This study was supported internally by the Nemours Foundation. The device was purchased using internal funding from our institution’s Telehealth Department budget.

Compliance with Ethical Standards

Conflict of interest

Drs. Behere, Baffa, and Penfil report no conflicts of interest. Following the completion of this study, Dr. Slamon agreed to serve as an independent consultant for Eko.

Ethical Approval

IRB approval was obtained prior to initiating the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent of parents and assent of patients (for those aged 7–17 years old) was obtained prior to acquiring the recordings.

Supplementary material

246_2018_1972_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Shashank Behere
    • 1
  • Jeanne Marie Baffa
    • 1
  • Scott Penfil
    • 2
  • Nicholas Slamon
    • 1
    Email author
  1. 1.Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Sinai Hospital of BaltimoreBaltimoreUSA

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