Value of a cardiovascular limited ultrasound examination using a hand-carried ultrasound device on clinical management in an outpatient medical clinic

Abstract

Limited ultrasound imaging studies using hand-carried ultrasound devices at the point of care have individually shown feasibility in the detection of carotid atheroma, left ventricular systolic dysfunction, left atrial enlargement, and abdominal aortic aneurysm. To evaluate the utility of a specific cardiovascular limited ultrasound examination (CLUE) designed to detect all 4 entities in patients seen in an outpatient medical clinic. One hundred ninety-six patients underwent coronary heart disease risk stratification by National Cholesterol Education Program guidelines and CLUE with a hand-carried ultrasound device with cardiac and vascular transducers. CLUE included brief imaging of the carotid arteries, the heart, and the intra-abdominal aorta. The prevalence of abnormal CLUE results and their effect on clinical management were tabulated and stratified by coronary heart disease risk class. Patient age (mean +/- SD) was 56 +/- 14 years (range 22 to 95), and 32.1% were at low risk, 30.6% at intermediate risk, and 37.2% at high risk. Of the 196 CLUEs, abnormalities were present in 37.2% (32.7% had carotid atheroma, 3.1% had systolic dysfunction, 6.1% had left atrial enlargement, and 1.0% had abdominal aortic aneurysm) and were related to age, increasing coronary heart disease risk, and male gender. Overall, CLUE resulted in new management recommendations in 20% of patients, primarily in coronary heart disease risk prevention. In patients at intermediate risk or aged 60 to 69 years, CLUE resulted in new recommendations in 39% and 37%, respectively. In conclusion, when applied to a clinic population, brief cardiovascular ultrasound exams frequently demonstrate unsuspected findings that can change management.