• Jeffrey A Marbach, Aws Almufleh, Pietro Di Santo, Richard Jung, Trevor Simard, Matthew McInnes, Jean-Paul Salameh, Trevor A McGrath, Scott J Millington, Gretchen Diemer, Frances Mae West, Marie-Cecile Domecq, and Benjamin Hibbert.
• University of Ottawa Heart Institute, Ottawa, Ontario, Canada (J.A.M., R.J., T.S.).
• Ann. Intern. Med. 2019 Aug 20; 171 (4): 264-272.

BackgroundIncorporating focused cardiac ultrasonography (FoCUS) into clinical examination could improve the diagnostic yield of bedside patient evaluation.PurposeTo 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 SourcesEnglish-language searches of MEDLINE, Embase, and Web of Science from 1 January 1990 to 23 May 2019 and review of reference citations.Study SelectionEligible 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 ExtractionThree study investigators independently abstracted data and assessed study quality.Data SynthesisNine 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%).LimitationEvidence was scant, persons doing ultrasonography had variable skill levels, and most studies had unclear or high risk of bias.ConclusionClinical 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 SourceNone. (PROSPERO: CRD42019124318).

5 keywords...

hide…