Focused Cardiac Ultrasound: Where Do We Stand?

Echocardiography (JM Gardin, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Echocardiography

Abstract

Focused cardiac ultrasound (FCU) is a bedside examination of the heart performed with a small, portable ultrasound platform by a physician as an adjunct to their physical examination. The goal is to recognize a narrow list of abnormalities that are both detectable by physicians with limited ultrasound training and have high clinical assessment value. Results from the FCU examination are integrated with traditional bedside assessment (physical examination and history) to provide early management plans and patient triage in settings when echocardiography cannot be obtained or is not immediately available.

Keywords

Focused cardiac ultrasound Bedside cardiac ultrasound Ultrasound-augmented physical examination 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Cardim N, Golfin CF, Ferreira D, Aubele A, Toste J, Cobos MA, et al. Usefulness of a new miniaturized echocardiographic system in outpatient cardiology consultations as an extension of physical examination. J Am Soc Echocardiogr. 2011;24:117–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Egan M, Ionescu A. The pocket echocardiograph: a useful new tool? Eur J Echocardiogr. 2008;9:721–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Frederiksen CA, Juhl-Olsen P, Larsen UT, Nielsen DG, Eika B, Sloth E. New pocket echocardiography device is interchangeable with high-end portable system when performed by experienced examiners. Acta Anaesthesiol Scand. 2010;54:1217–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Giusca S, Jurcut R, Ticulescu R, Dumitru D, Vladaia A, Savu O, et al. Accuracy of handheld echocardiography for bedside diagnostic evaluation in a tertiary cardiology center: comparison with standard echocardiography. Echocardiography. 2011;28:136–41.CrossRefPubMedGoogle Scholar
  5. 5.
    Kimura BJ, Gilcrease GW, Showalter BK, Phan JN, Wolfson T. Diagnostic performance of a pocket-sized ultrasound device for quick-look cardiac imaging. Am J Emerg Med. 2012;30:32–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Liebo MJ, Israel RL, Lillie EO, Smith MR, Rubenson DS, Topol EJ. Is pocket mobile echocardiography the next-generation stethoscope? A cross-sectional comparison of rapidly acquired images with standard transthoracic echocardiography. Ann Intern Med. 2011;155:33–U75.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    Reant P, Dijos M, Arsac F, Mignot A, Cadenaule F, Aumiaux A, et al. Validation of a new bedside echoscopic heart examination resulting in an improvement in echo-lab workflow. Arch Cardiovasc Dis. 2011;104:171–7.CrossRefPubMedGoogle Scholar
  9. 9.•
    Gianstefani S, Catibog N, Whittaker AR, Ioannidis AG, Vecchio F, Wathen PT, et al. Pocket-size imaging device: effectiveness for ward-based transthoracic studies. Eur Heart J Cardiovasc Imaging. 2013;14:1132–9. Despite their small size, ultrasound devices which fit in a labcoat pocket are capable of providing clinically useful images at the bedside.CrossRefPubMedGoogle Scholar
  10. 10.
    Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22:442.CrossRefGoogle Scholar
  11. 11.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group. J Am Soc Echocardiogr. 2005;18:1440–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound. J Am Soc Echocardiogr. 2009;22:975–1014.CrossRefPubMedGoogle Scholar
  14. 14.
    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.CrossRefPubMedGoogle Scholar
  15. 15.
    Rudski LG, Lai WW, Afilalo J, Hua LQ, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults. J Am Soc Echocardiogr. 2010;23:685–713.CrossRefPubMedGoogle Scholar
  16. 16.
    Bierig SM, Ehler D, Knoll ML, Waggoner AD. American society of echocardiography minimum standards for the cardiac sonographer: a position paper. J Am Soc Echocardiogr. 2006;19:471–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Picard MH, Adams D, Bierig SM, Dent JM, Douglas PS, Gillam LD, et al. American society of echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr. 2011;24:1–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Quinones MA, Douglas PS, Foster E, Gorcsan J, Lewis JF, Pearlman AS, et al. ACC/AHA clinical competence statement on echocardiography. J Am Soc Echocardiogr. 2003;16:379–402.CrossRefPubMedGoogle Scholar
  19. 19.
    Ehler D, Carney DK, Dempsey AL, Rigling R, Kraft C, Witt SA, et al. Guidelines for cardiac sonographer education: recommendations of the American Society of Echocardiography Sonograpber Training and Education Committee. J Am Soc Echocardiogr. 2001;14:77–84.CrossRefPubMedGoogle Scholar
  20. 20.••
    Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26:567–81. This is a comprehensive review on the topic of FCU, benefits, limitations, clinical use scenarios and recommendations for training.CrossRefPubMedGoogle Scholar
  21. 21.
    Andersen GN, Haugen BO, Graven T, Salvesen O, Mjolstad OC, Dalen H. Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur J Echocardiogr. 2011;12:665–70.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Coletta C, De Marchis E, Lenoli M, Rosato S, Renzi M, Sestili A, et al. Reliability of cardiac dimensions and valvular regurgitation assessment by sonographers using hand-carried ultrasound devices. Eur J Echocardiogr. 2006;7:275–83.CrossRefPubMedGoogle Scholar
  23. 23.
    DeCara JM, Lang RM, Koch R, Bala R, Penzotti J, Spencer KT. The use of small personal ultrasound devices by internists without formal training in echocardiography. Eur J Echocardiogr. 2002;4:141–7.CrossRefGoogle Scholar
  24. 24.
    Fukuda S, Shimada K, Kawasaki T, Fujimoto H, Maeda K, Inanami H, et al. Pocket-sized transthoracic echocardiography device for the measurement of cardiac chamber size and function. Circ J. 2009;73:1092–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Galderisi M, Santoro A, Versiero M, Lomoriello VS, Esposito R, Raia R, et al. Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study. Cardiovasc Ultrasound 2010;8:51.Google Scholar
  26. 26.
    Mjolstad OC, Dalen H, Graven T, Kleinau JO, Salvesen O, Haugen BO. Routinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department. Eur J Int Med. 2012;23:185–91.CrossRefGoogle Scholar
  27. 27.•
    Panoulas VF, Daigeler A, Malaweera ASN, Lota AS, Baskaran D, Rahman S, et al. Pocket-sized hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging. 2012;14:323–30. This paper demonstrates the clear incremental value of FCU in the hands of inexperienced users over use of physical examination and EKG alone.CrossRefPubMedGoogle Scholar
  28. 28.
    Scholten C, Rosenhek R, Binder T, Zehetgruber M, Maurer G, Baumgartner H. Hand-held miniaturized cardiac ultrasound instruments for rapid and effective bedside diagnosis and patient screening. J Eval Clin Pract. 2005;11:67–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Testuz A, Muller H, Keller PF, Meyer P, Stampfli T, Sekoranja L, et al. Diagnostic accuracy of pocket-size handheld echocardiographs used by cardiologists in the acute care setting. Eur Heart J. 2012;33:857–8.CrossRefGoogle Scholar
  30. 30.
    Prinz C, Dohrmann J, van Buuren F, Bitter T, Bogunovic N, Horstkotte D, et al. 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.CrossRefPubMedGoogle Scholar
  31. 31.
    Croft LB, Duvall WL, Goldman ME. A pilot study of the clinical impact of hand-carried cardiac ultrasound in the medical clinic. Echocardiography. 2006;23:439–46.CrossRefPubMedGoogle Scholar
  32. 32.
    Fedson S, Neithardt G, Thomas P, Lickerman A, Radzienda M, DeCara JM, et al. Unsuspected clinically important findings detected with a small portable ultrasound device in patients admitted to a general medicine service. J Am Soc Echocardiogr. 2003;16:901–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Ghani SN, Kirkpatrick JN, Spencer KT, Smith GL, Burke MC, Kim SS, et al. Rapid assessment of left ventricular systolic function in a pacemaker clinic using a hand-carried ultrasound device. J Interv Card Electrophysiol. 2006;16:39–43.CrossRefPubMedGoogle Scholar
  34. 34.
    Kirkpatrick JN, Belka V, Furlong K, Balasia B, Jacobs LD, Corcoran M, et al. Effectiveness of echocardiographic imaging by nurses to identify left ventricular systolic dysfunction in high-risk patients. Am J Cardiol. 2005;95:1271–2.CrossRefPubMedGoogle Scholar
  35. 35.
    Kirkpatrick JN, Ghani SN, Spencer KT. Hand carried echocardiography screening for LV systolic dysfunction in a pulmonary function laboratory. Eur J Echocardiogr. 2008;9:381–3.PubMedGoogle Scholar
  36. 36.
    Lucas BP, Candotti C, Margeta B, Evans AT, Mba B, Baru J, et al. Diagnostic accuracy of hospitalist-performed hand-carried ultrasound echocardiography after a brief training program. J Hosp Med. 2009;4:340–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Melamed R, Sprenkle MD, Ulstad VK, Herzog CA, Leatherman JW. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest. 2009;135:1416–20.CrossRefPubMedGoogle Scholar
  38. 38.
    Vignon P, Dugard A, Abraham J, Belcour D, Gondran G, Pepino F, et al. Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit. Intensive Care Med. 2007;33:1795–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Bustam A, Azhar MN, Veriah RS, Arumugam K, Loch A. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J. 2014;31:369–73.CrossRefPubMedGoogle Scholar
  40. 40.
    Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. A comparison by medicine residents of physical examination versus hand-carried ultrasound for estimation of right atrial pressure. Am J Cardiol. 2007;99:1614–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Kimura BJ, Amundson SA, Willis CL, Gilpin EA, DeMaria AN. Usefulness of a hand-hold ultrasound device for bedside examination of left ventricular function. Am J Cardiol. 2002;90:1038–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Kobal SL, Trento L, Baharami S, Tolstrup K, Naqvi TZ, Cercek B, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol. 2005;96:1002–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Martin LD, Howell EE, Ziegelstein RC, Martire C, Whiting-O’Keefe QE, Shapiro EP, et al. Hand-carried ultrasound performed by hospitalists: does it improve the cardiac physical examination? Am J Med. 2009;122:35–41.CrossRefPubMedGoogle Scholar
  44. 44.•
    Razi R, Estrada JR, Doll J, Spencer KT. Bedside hand-carried ultrasound by internal medicine residents versus traditional clinical assessment for the identification of systolic dysfunction in patients admitted with decompensated heart failure. J Am Soc Echocardiogr. 2011;24:1319–24. This paper demonstrates the value of FCU in real clinical pratice of caring for patients with acutely decompensated heart failure.CrossRefPubMedGoogle Scholar
  45. 45.
    Shmueli H, Burstein Y, Sagy I, Perry ZH, Ilia R, Henkin Y, et al. Briefly trained medical students can effectively identify rheumatic mitral valve injury using a hand-carried ultrasound. Echocardiography. 2013;30:621–6.CrossRefPubMedGoogle Scholar
  46. 46.
    Goonewardena SN, Blair JEA, Manuchehry A, Brennan JM, Keller M, Reeves R, et al. Use of hand carried ultrasound, B-type natriuretic peptide, and clinical assessment in identifying abnormal left ventricular filling pressures in patients referred for right heart catheterization. J Card Fail. 2010;16:69–75.CrossRefPubMedGoogle Scholar
  47. 47.
    Kimura BJ, Fowler SJ, Fergus TS, Minuto JJ, Amundson SA, Gilpin EA, et al. Detection of left atrial enlargement using hand-carried ultrasound devices to screen for cardiac abnormalities. Am J Med. 2005;118:912–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Martin LD, Howell EE, Ziegelstein RC, Martire C, Shapiro EP, Hellmann DB. Hospitalist performance of cardiac hand-carried ultrasound after focused training. Am J Med. 2007;120:1000–4.CrossRefPubMedGoogle Scholar
  49. 49.
    Perez-Avraham G, Kobal SL, Etzion O, Novack V, Wolak T, Liel-Cohen N, et al. Left ventricular geometric abnormality screening in hypertensive patients using a hand-carried ultrasound device. J Clin Hypertens. 2010;12:181–6.CrossRefGoogle Scholar
  50. 50.
    Mark DG, Ku BS, Carr BG, Everett WW, Okusanya O, Horan A, et al. Directed bedside transthoracic echocardiography: preferred cardiac window for left ventricular ejection fraction estimation in critically ill patients. Am J Emerg Med. 2007;25:894–900.CrossRefPubMedGoogle Scholar
  51. 51.
    Hellmann DB, Whiting-O’Keefe Q, Shapiro EP, Martin LD, Martire C, Ziegelstein RC. The rate at which residents learn to use hand-held echocardiography at the bedside. Am J Med. 2005;118:1010–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Culp BC, Mock JD, Chiles CD, Culp WC. The pocket echocardiograph: validation and feasibility. Echocardiography. 2010;27:759–64.CrossRefPubMedGoogle Scholar
  53. 53.
    Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010;23:1225–30.CrossRefPubMedGoogle Scholar
  54. 54.
    Gunst M, Ghaemmaghami V, Sperry J, Robinson M, O’Keeffe T, Friese R, et al. Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma/critical care. J Trauma-Inj Infect Crit Care. 2008;65:509–15.CrossRefGoogle Scholar
  55. 55.
    Mark DG, Hayden GE, Ky B, Paszczuk A, Pugh M, Matthews S, et al. Hand-carried echocardiography for assessment of left ventricular filling and ejection fraction in the surgical intensive care unit. J Crit Care 2009;24:470.e1–7.Google Scholar
  56. 56.
    Stawicki SP, Braslow BM, Panebianco NL, Kirkpatrick JN, Gracias VH, Hayden GE, et al. Intensivist use of hand-carried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: correlations with CVP. J Am Coll Surg. 2009;209:55–61.CrossRefPubMedGoogle Scholar
  57. 57.
    Vignon P, Chastagner C, Francois B, Martaille JF, Normand S, Bonnivard M, et al. Diagnostic ability of hand-held echocardiography in ventilated critically ill patients. Crit Care. 2003;7:R84–91.CrossRefPubMedCentralPubMedGoogle Scholar
  58. 58.
    Breitkreutz R, Price S, Steiger HV, Seeger FH, Ilper H, Ackermann H, et al. Focused echocardiographic evaluation in life support and pen-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010;81:1527–33.CrossRefPubMedGoogle Scholar
  59. 59.
    Tayal VS, Beatty MA, Marx JA, Tomaszewski CA, Thomason MH. FAST (Focused Assessment with Sonography in Trauma) accurate for cardiac and intraperitoneal injury in penetrating anterior chest trauma. J Ultrasound Med. 2004;23:467–72.PubMedGoogle Scholar
  60. 60.
    Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. J Am Soc Echocardiogr. 2011;24:229–67.CrossRefPubMedGoogle Scholar
  61. 61.
    Goonewardena SN, Gemignani A, Ronan A, Vasaiwala S, Blair J, Brennan JM, et al. Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure. JACC-Cardiovasc Imaging. 2008;1:595–601.CrossRefPubMedGoogle Scholar
  62. 62.
    Galasko GIW, Barnes SC, Collinson P, Lahiri A, Senior R. What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination? Eur Heart J. 2006;27:193–200.CrossRefPubMedGoogle Scholar
  63. 63.
    Kirkpatrick JN, Davis A, Decara JM, Hong AE, Kurtz PL, Balasia B, et al. Hand-carried cardiac ultrasound as a tool to screen for important cardiovascular disease in an underserved minority health care clinic. J Am Soc Echocardiogr. 2004;17:399–403.CrossRefPubMedGoogle Scholar
  64. 64.
    Khan HA, Wineinger NE, Uddin PQ, Mehta HS, Rubenson DS, Topol EJ. Can hospital rounds with pocket ultrasound by cardiologists reduce standard echocardiography? Am J Med. 2014;127:669 e1-7.CrossRefPubMedGoogle Scholar
  65. 65.
    Blair JE, Brennan JM, Goonewardena SN, Shah D, Vasaiwala S, Spencer KT. Usefulness of hand-carried ultrasound to predict elevated left ventricular filling pressure. Am J Cardiol. 2009;103:246–7.CrossRefPubMedGoogle Scholar
  66. 66.
    ACEP. Emergency ultrasound guidelines. Ann Emerg Med. 2009;53:550–70.CrossRefGoogle Scholar
  67. 67.
    Burwash IG, Basmadjian A, Bewick D, Choy JB, Cujec B, Jassal DS, et al. 2010 Canadian cardiovascular society/Canadian society of echocardiography guidelines for training and maintenance of competency in adult echocardiography. Can J Cardiol. 2011;27:862–4.CrossRefPubMedGoogle Scholar
  68. 68.
    Cholley BP. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37:1077–83.CrossRefGoogle Scholar
  69. 69.
    Sicari R, Galderisi M, Voigt JU, Habib G, Zamorano JL, Lancellotti P, et al. The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography. Eur J Echocardiogr 2011;12:85–7.Google Scholar
  70. 70.
    Nair P, Siu SC, Sloggett CE, Biclar L, Sidhu RS, Yu EHC. The assessment of technical and interpretative proficiency in echocardiography. J Am Soc Echocardiogr. 2006;19:924–31.CrossRefPubMedGoogle Scholar
  71. 71.•
    Kimura BJ, Amundson SA, Phan JN, Agan DL, Shaw DJ. Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination. J Hosp Med. 2012;7:537–42. For FCU to flourish, training programs need to be developed. This paper makes interesting and practical observations on development of an FCU training program.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.University of ChicagoChicagoUSA

Personalised recommendations