ArticleEcho research and practice2025
Assessment of limited cardiac ultrasound to screen for mitral regurgitation.
Article in Echo research and practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMitral regurgitation (MR) is under-diagnosed and under-treated. Point-of-care ultrasound devices now include color Doppler technologies that can enhance the physical exam. Focused handheld imaging protocols might improve detection of mitral regurgitation.
methodsPatients were prospectively scanned with a limited protocol using the Butterfly IQ + device at Tufts Medical Center (Boston, MA). Comprehensive staging of MR was done with cart-based transthoracic echocardiography (TTE) during the same encounter. Handheld imaging-based MR severity was assessed by a board certified echocardiographer blinded to the cart-based results. Performance of handheld color Doppler imaging for identifying significant MR was assessed across a range of disease prevalence values.
results100 patients were prospectively scanned, 45% were women. The median age was 75 (IQR 70–80). The Median LVEF was 60 (IQR 54–64%). Overall, 44 (44%) had some degree of MR. 8 (8%) had significant MR, defined as ≥ moderate. The sensitivity of handheld parasternal long axis color Doppler imaging for the detection of ≥ moderate MR was poor (38% 95% CI 8.5% − 75.5%). PPV and NPV ranged from 25% to 60% and 91.9%-98.9%, across a range of potential disease prevalence rates. There was poor agreement between handheld ultrasound and TTE derived MR grade (weighted kappa 0.08, 95% CI -0.01–0.17). There was modest correlation between assigned grades by each imaging method (Spearman r = 0.41, p < 0.001).
conclusionsLimited handheld color Doppler imaging has limited value in screening for significant mitral regurgitation. Routine assessment of handheld imaging protocols proposed for cardiac disease detection are needed. CLINICAL TRIAL NUMBER: Not applicable.
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