portable spectral doppler echocardiographic device: overcoming limitations - lithium ion rechargeable battery

Background: there is evidence that the new portable ECG device is useful in assessing the anatomy and function of the heart, but so far the lack of Doppler pattern has been one of the ways to obtain the data of the blood flow dynamics
Objective: to report the Doppler function of a new hand-held ultrasound heartbeat device.
Design: comparison of two blind methods of ultrasound heartbeat.
Location: tertiary care center.
Patients: 98 consecutive patients were randomly imaged with handheld devices for reference on the standard platform.
Results measurements: the Pulse-wave-transmitted dorpule flow-in velocity, deceleration time, and continuous wave Doppler measurements of peak velocity of aortic ejection and triple-pointed valve reflux were recorded.
Results: the hand-held devices of the protocol between the superior and the standard ultrasound heartbeat evaluated the pulse Doppler of the Shu E and A waves, the E/A ratio and the stop time (
The intra-class correlation coefficient of 0. 97, 0. 93, 0. 90, and 0.
78 respectively. .
In addition, a good consistency was found between continuous wave Doppler measurement of aortic ejection and three-tip blood flow velocity (
The intra-class correlation coefficient of 0. 96 and 0. 80).
However, there was a significant difference between patients who had been closed with a handhold device (25. 5%)
Standard Ultrasound (65. 3%)
It resulted in 8 patients with obvious pulmonary hypertension who were diagnosed with misdiagnosis.
Conclusion: The new handheld device with Doppler function overcomes the limitations of previous evaluation of blood dynamics variables.
By color Doppler, they are now suitable for assessing valvar disease and cardiac retraction function.
However, there are still important limitations in assessing lung pressure.
We used the SonoHeart elite (
Sonoma company (Washington, United States of America)
Portable ECG system
The device has an integrated 12.
7 cm TFT color LCD with brightness and contrast control, 33.
Height 8 cm, 19.
Width 3 cm, 6.
35 cm deep, heavy 2.
6 kg, is the battery (
Rechargeable Lithium Ion)
Or AC power supply.
15mm broadband (4–2 MHz)
A phase array sensor for breast imaging and for providing continuous and pulse wave Doppler.
Together with the Doppler function, SonoHeart provides cross-sectional images enhanced by extended resolution harmonics and is synchronized with the patient's ECG as well as the M-mode and directional color power Doppler.
The control settings are similar to the standard platform, where up to 119 images can be stored internally.
It can be connected to a video recorder, video recorder or an external monitor.
To speed up the calculation, it is equipped with a comprehensive trackball for navigation, two sets of distance calipers, and a heart computing software package.
Standard ultrasound heartbeat examination using Sonos 5500 (
Philips technology, Andover, USA)
And Sequoia 256 (Acuson (
Siemens Technology Corporation (Mountain View, California, USA)
Instruments equipped with harmonic imaging, pulse and continuous wave Doppler, and multi-frequency sensors.
We studied 98 patients who were not selected in a row (
50 women and 48 men; mean age 64. 2 years)
Refers to the laboratory of ultrasound heartbeat by chest ultrasound.
The registered patient is referred by a doctor, either admitted to the hospital or at the clinic.
The indications for referral are: 23 patients with ischemic heart disease, 17 patients with hypertension, 16 patients with arrhythmias, 12 patients with valvar heart disease, 9 patients with clear heart murmur, and 6 cases of heart failure, 15 other indications.
The study was designed to test the Doppler accuracy of handheld devices, and we conducted a validation study based on side-by-side comparison with standard ultrasound heartbeat measurements of pulse and continuous wave Doppler.
All patients were examined by two consecutive ultrasound cardiologists with experience in ultrasound (
According to the American Institute of ultrasound heartbeat, professional knowledge level 2.
The patient was first imaged with a handheld device, followed by a standard examination by a second investigator, but turned a blind eye to previous findings.
Both of them had a complete heart test, which was based on the side length of the plaster, the short-axis view, and the two, three, and four-cavity view of the apex.
The pulse wave Doppler ultrasound heartbeat map was used to locate the sample volume from the four-chamber view of the tip of the heart at the tip of the second tip to obtain the velocity of the heart's comfortable left ventricular inflow, following the advice of the American Institute of Cardiac Ultrasound.
Measurement of wave velocity of E and (Sinus rhythm)
Their ratio and the deceleration time of the e-wave were recorded.
Continuous wave Doppler measurements of aortic shot blood and three-tip reverse maximum velocity were obtained from the five-chamber and the four-chamber view of the apex, respectively, to keep the parallel direction between the acoustic beam and the blood flow as much as possible.
9 as a secondary target, the information on blood flow dynamics obtained after the conversion of continuous wave Doppler measurements was compared to calculate the sensitivity and specificity of handheld devices to assess aortic stenosis and hypertension.
By applying the simplified bonuli equation: pressure gradient = 4V2, the rate of closure of the aorta and three-valve is converted into a pressure gradient.
The maximum speed of the aorta is divided into mild, moderate and severe aortic stenosis according to the preset limit (
250-350 cm/s mild, 350-400 cm/s moderate and> 400 cm/s severe aortic stenosis).
As mentioned earlier, the right heart systolic blood pressure is calculated.
10 It is assumed that when there is no gradient on the pulmonary valve and normal right heart outflow tract morphology can be shown, it is the same as the systolic blood pressure.
The obvious pulmonary high pressure was defined as the calculated systolic blood pressure (BP) 50mm Hg, and the patients were divided into two groups: those with a pressure of 50mm Hg and those with a lower pressure.
In order to calculate the variability between observers, researchers operating handheld devices Retrieved standard ECG tapes and reported several sets of cross-sectional data and measurements that turned a blind eye to patient identity in a previously described manner
2,5 statistical analysis descriptive statistical report is the median and four-digit interval, which is due to the non-
Normal distribution of variables.
Using intra-class correlation coefficients, 11, 12 taking into account values below 0, the consistency between Doppler measurements was evaluated with reliability analysis. 4, between 0. 4 and 0. 75, and above 0.
Representing poor, fair and good agreements, respectively.
Since neither of the devices compared provided a clearly correct measurement, we also evaluated the degree of consistency using the graphic techniques described by Bland and Altman.
13, 14 use the linear weighted k index to evaluate the consistency between the data reported in a classification manner, and 15 consider the value of ⩽ 0. 2, 0. 21–0. 4, 0. 41–0. 6, 0. 61–0. 80, and ⩾ 0.
An agreement that represents poverty, fairness, moderation, good and excellence.
Results in all patients using standard ultrasound heartbeat devices, E-wave Doppler measurements were feasible for all patients except for two handheld devices.
After patients with atrial fibrillation were excluded, A wave was measured in all the remaining parts with standard ultrasound heartbeat, except for three waves measured with handheld devices.
If there are these two measures, the E/A ratio is calculated.
Table 1 summarizes the results of pulse and continuous wave Doppler measurements. The median (
Four-digit range)
For the E-wave measurement is 77 (36. 5)
With standard platform and 76 cm/s. 5 (34. 7)
CM/sec for handheld devices;
A wave measurement is 79 (40)
Cm/s and 79 with standard platform. 5 (31)
Cm/s with handheld devices.
The E/A ratio calculated with standard and handheld devices is 0. 9 (0. 6)and 1. 0 (0. 5), respectively.
It was found that the measurement between the two devices was very consistent, and the correlation coefficient within the class was 0. 97, 0. 93, and 0.
The ratio of E wave, A wave and E/A is 9, respectively.
Using standard ultrasound heartbeat and pulse wave Doppler for handheld devices, we evaluated the deceleration interval and found a good consistency between the two devices: 216. 8 (123. 8)
Perform MS using standard equipment and 242. 4 (119. 5)
Handheld devices are MS with a correlation coefficient of 0 in the group. 78.
Table 1 shows the continuous wave Doppler measurements of the two examination techniques for the maximum forward velocity of the aorta and the maximum velocity of the valve closure.
The median value of continuous wave Doppler velocity obtained by the standard device is higher than the median obtained by the handheld device;
Nevertheless, the consistency between the two technologies is very good (
The intra-class correlation coefficient of 0. 96 and 0.
The peak velocity of aortic anterior margin and aortic reflux was 8, respectively).
The information obtained after conversion of continuous wave Doppler aortic measurement is shown in Table 2.
Find a 96% protocol with a weighted k of 0. 86 (
Good agreement.
, But in four patients, a first-level assessment of the extent of aortic stenosis was encountered with handheld devices.
View this table: according to the peak aortic velocity assessment, check the consistency of the classification of the severity of aortic stenosis in line View popupTable 2, there are significant differences between standard ultrasound heartbeat equipment and handheld ultrasound heartbeat equipment23. 5%)
Standard Ultrasound (65. 3%).
As shown in Table 3, of the 23 patients measured by these two devices, 3 had obvious pulmonary hypertension, all of which were properly classified with handheld devices.
However, in the rest of the patients only measured by standard ultrasound, 8 cases of obvious pulmonary hypertension were misdiagnosed.
View this table: see if there is an obvious pulmonary hypertension in the inline View pop-up table 3 (⩾50 mm Hg)
The classification was performed according to the peak aortic valve closing speed measured by standard ultrasound heartbeat equipment and hand-held ultrasound heartbeat equipment. Figures 1 and 2 show the graphical methods described by Bland and Altman13, comparing a new measurement method with the established techniques
Compared with the measured mean values obtained by the two devices, the difference map allows us to examine the distribution of the differences within the two standard deviations, providing a consistent limit between the ultrasound heartbeat devices.
Download new tabDownload powerpointFigure 1Bland-
The Altman chart shows the difference between the hand-held ultrasound heartbeat map and the standard ultrasound heartbeat pulse wave Doppler measurement.
The average of the difference and 1.
Standard deviation (SD)
Shows the size of the average difference.
Download new tabDownload powerpointFigure 2 bland-
The Altman chart shows the difference between the maximum aortic velocity measured with the hand-held ultrasound heartbeat and the standard ultrasound heartbeat and the continuous Doppler measurement of the aortic valve closing velocity. 1. 96 (SD), 1.
Standard deviation of mean difference 96.
Figure 1 shows the graphical analysis of pulse Doppler E and A waves.
The mean value of the difference measured by both methods is close to zero, and the consistent limit is about ± 25-30 cm/s, and the E-Bobby A wave is measured more closely.
Consistency limit for continuous Doppler measurement (fig 2)
Oscillation between-93 and-60 cm/s (lower limit)
Between 27 and 30 cm/s (upper limit)
, Wider when measuring the maximum speed of the three-valve reflux.
The mean difference between the two devices is negative, which means that the value of the handheld device is lower.
There was a good correlation between the observer differences between the two independent investigators, with the difference between observers being 3%.
The ultrasound heartbeat is a technique widely used in the Department of Cardiology, which provides accurate anatomical and functional data.
The use of Doppler ultrasound heartbeat maps provides unique information on blood flow dynamics that will not be available without invasive monitoring.
To date, the widespread use of this technology has been limited by the size and cost of the equipment.
However, micromation in the form of a handheld ultrasound camera, the size and digital technology of the laptop may overcome these obstacles.
Several hand-held ultrasound units have been developed for the heart examination at the point of care, designed to improve the accuracy of bedside physical examination and allow for a faster assessment of cardiovascular anatomy, physiology and function.
A small number of limited comparative studies have shown that these devices are more accurate than physical examinations, although their diagnostic performance is generally lower than that of the standard sonogram, and there seems to be a close agreement between the two types of devices.
The previous comparative studies of 2-7, 16, and 17 were conducted by cardiologists with experience in cardiac ultrasound (
Level II or III)
And follow the instructions of the American Society of cardiac ultrasound guidelines.
8, 18 secondary competence indicates that there is sufficient experience to accurately and independently interpret the images in the ultrasound heartbeat examination.
8 handheld devices appear to be suitable for assessing the morphology and function of the heart, and 2, 5, 6, 3 or even for screening of the main aneurysm.
4 However, due to the lack of a spectrum Doppler facility, signs of pulmonary high pressure, obstruction of inflow or outflow, and dysfunction of cardiac retraction may be missed.
Recently, to overcome this limitation, spectral Doppler technology has been incorporated into handheld devices, but so far there is no public information about this new technology.
Our study shows that there is a good correlation between pulse and continuous wave Doppler measurements performed with handheld devices and standard ultrasound heartbeat platforms.
This will lead to improvements in the heart assessment, especially in the assessment of valve function and cardiac retraction function.
Evaluation of the left ventricle's cardiac retraction dysfunction seems to be the earliest manifestation of myocardial ischemia, and 21 years old is the main cause of heart failure with retained cardiac contraction function, accounting for 40% of the accident cases.
22 Doppler ultrasound heartbeat map is one of the most useful clinical tools for evaluating the function of left heart compression and should be part of routine ultrasound heartbeat assessment in patients with suspected heart failure.
The Doppler index of left ventricular filling is readily available and provides immediate information about the function of the heart's retraction.
In addition, the standard platform is equipped with color M-mode and Tissue Doppler to accurately evaluate the function of cardiac contraction.
These new Doppler applications have been shown to provide an accurate estimate of left ventricular relaxation, and appear to be relatively insensitive to the effects of pre-load compensation.
The design of the handheld device makes it easy to perform an ultrasound heartbeat examination when evaluating patients.
A Doppler assessment of the cardiac comfort function using a handheld device using inflow channel speed will add valuable screening information that can be examined later using standard ultrasound heartbeat maps.
Evaluation of aortic outflow obstruction lack of spectrum Doppler in handheld devices is an important limitation of complete valve assessment.
Previously, valve studies in handheld devices were limited to morphological assessment and subjective assessment of valve reflux by color Doppler.
Despite the limitations, the valve return was accurately detected in the first generation of handheld devices.
The new Doppler function will allow complete valve assessment including valve stenosis.
Using the bonuli equation, Doppler measurements can easily be converted into information on the blood flow dynamics.
In most physiological conditions, this formula is very accurate when estimating the pressure gradient of the restricted hole, 23-25, when the valve is closed, the equation is applied to the peak valve closing speed, accurate estimation of peak pressure gradient between right and right atrium is provided.
In contrast, in the absence of a defined direction, the simplified bonuli equation is inaccurate in assessing the pressure gradient in the heart.
In our study, although most patients did not have valve stenosis, although the use of a peak gradient alone was not sufficient to accurately detect aortic stenosis, the diagnostic consistency between the two ECG devices reached 96%, only four patients were diagnosed with a degree of stenosis, corresponding to a lower level of severity.
As shown in Figure 2, the most likely inconsistency is 60 cm/s, which will result in a difference of not more than one grade at the time of estimation of severity.
A key part of the assessment of pulmonary high pressure ultrasound heartbeat examination is the determination of pulmonary artery pressure and right heart function.
The main limitations of the evaluation of lung pressure by ultrasound heartbeat are poor image quality and low Doppler signal intensity.
In addition, the absence of documented triple-tip reflux does not indicate normal lung pressure.
In our study, we found a good consistency in assessing lung pressure;
However, a significant difference in the number of patients with a detection of a triple valve closure has led to a number of cases of misdiagnosis.
Conclusion when a cardiologist with experience in an ultrasound heartbeat uses a hand-held ultrasound heartbeat device, the sour results support the diagnostic value of the built-in spectrum Doppler device.
In this device, Doppler can provide accurate measurements, comparable to the measurement results of the standard platform, overcoming the limitations encountered in previous studies.
Therefore, the new Doppler function of the handheld device may lead to a wider application of the ultrasound heartbeat in clinical practice.
However, a major limitation of these devices is that many patients with hypertension are missing when determining pulmonary artery pressure.
Further research is needed to clarify the role of this new technology and the level of capabilities required to conduct research with handheld devices.
We would like to thank the research unit at the General Hospital of Gregorio maraón, in particular JM bellon, and the experts for their statistical advice.
We would also like to thank Professor JC Kaski and Dr. D Roy for their helpful comments and constructive criticism.
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