{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T22:21:17Z","timestamp":1773786077845,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The professional association has already developed guidelines on the appropriate use of handheld ultrasound devices, especially in an emergency setting. Handheld ultrasound devices are seen as the \u2018stethoscope of the future\u2019 to assist in physical examination. Our exploratory study evaluated whether the measurements of cardiovascular structures and the agreement in identifying aortic, mitral, and tricuspid valve pathology made by a resident with a handheld device (HH, Kosmos Torso-One) reach the results reported by an experienced examiner who used a high-end device (STD). Patients referred for cardiology examination in a single center from June to August 2022 were eligible for the study. Patients who agreed to participate underwent two heart ultrasound examinations scanned by the same two operators. A cardiology resident performed the first examination with a HH ultrasound device, and an experienced examiner performed the second examination with an STD device. Forty-three consecutive patients were eligible, and forty-two were included in the study. One obese patient was excluded because none of the examiners succeeded in performing the heart examination. The measurements obtained with HH were generally higher than those obtained with STD, with the highest mean difference of 0.4 mm, but without significant differences (all 95% confidence intervals of the differences contain the value of 0). For valvular disease, the lowest agreement was observed for mitral valve regurgitation (26\/42, with a Kappa concordance coefficient of 0.5321), which was missed in almost half of the patients with mild regurgitation and underestimated in half of the patients with moderate mitral regurgitation. The measurements performed by the resident with the handheld Kosmos Torso-One device showed high concordance with those conducted by the experienced examiner with a larger high-end ultrasound device. The learning curve of the resident could explain the limited performance in identifying valvular pathologies between examiners.<\/jats:p>","DOI":"10.3390\/diagnostics13050853","type":"journal-article","created":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T03:56:58Z","timestamp":1677124618000},"page":"853","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Handheld Echocardiography Measurements Concordance and Findings Agreement: An Exploratory Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Mariam","family":"Haji-Hassan","sequence":"first","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan","family":"Du\u021bu","sequence":"additional","affiliation":[{"name":"Cardiology Section, Clinical Rehabilitation Hospital, Viilor Str., No. 46-50, 400437 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2342-4311","authenticated-orcid":false,"given":"Sorana D.","family":"Bolboac\u0103","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"key":"ref_1","unstructured":"Omerovic, S., and Jain, A. (2022, September 02). Echocardiogram, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK558940\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1093\/ehjci\/jew333","article-title":"EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: A report of literature and current practice review","volume":"18","author":"Steeds","year":"2017","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1177\/1751143720914216","article-title":"Handheld ultrasound in training\u2014The future is getting smaller!","volume":"22","author":"Wilkinson","year":"2020","journal-title":"J. Intensiv. Care Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/j.amjmed.2005.05.030","article-title":"The rate at which residents learn to use hand-held echocardiography at the bedside","volume":"118","author":"Hellmann","year":"2005","journal-title":"Am. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1016\/j.amjcard.2016.08.027","article-title":"Usefulness of Hand-Held Ultrasonography as a Gatekeeper to Standard Echocardiography for \u201cRarely Appropriate\u201d Echocardiography Requests","volume":"118","author":"Pathan","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_6","unstructured":"(2022, October 10). Vscan. Available online: https:\/\/vscan.rocks\/product\/vscanextend."},{"key":"ref_7","unstructured":"(2022, October 10). Clarius. Available online: https:\/\/clarius.com\/."},{"key":"ref_8","unstructured":"(2022, October 10). Medical Device Store. Available online: https:\/\/medicaldevicestore.ro\/produs\/ecograf-portabil-philips-lumify\/."},{"key":"ref_9","unstructured":"(2022, October 10). Butterfly iQ. Available online: https:\/\/www.butterflynetwork.com\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13089-022-00274-6","article-title":"Comparison of four handheld point-of-care ultrasound devices by expert users","volume":"14","author":"Le","year":"2022","journal-title":"Ultrasound J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12574-021-00540-x","article-title":"Cardiovascular examination using hand-held cardiac ultrasound","volume":"20","author":"Jenkins","year":"2021","journal-title":"J. Echocardiogr."},{"key":"ref_12","unstructured":"(2022, October 08). Echonous Platform. Available online: https:\/\/echonous.com\/en_us\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1093\/ehjci\/jeu081","article-title":"Focus cardiac ultrasound: The European Association of Cardiovascular Imaging viewpoint","volume":"15","author":"Neskovic","year":"2014","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"American College of Emergency Physicians (2009). Emergency Ultrasound Guidelines. Ann. Emerg. Med., 53, 550\u2013570.","DOI":"10.1016\/j.annemergmed.2008.12.013"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/j.echo.2010.10.005","article-title":"Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American Society of Echocardiography and American College of Emergency Physicians","volume":"23","author":"Labovitz","year":"2010","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2178","DOI":"10.1161\/CIRCULATIONAHA.117.026622","article-title":"Handheld Echocardiography: Current State and Future Perspectives","volume":"136","author":"Sengupta","year":"2017","journal-title":"Circulation"},{"key":"ref_17","unstructured":"American College of Emergency Physicians (2022, December 19). Appropriate use criteria for handheld pocket ultrasound devices: ACEP Policy Statement. Available online: https:\/\/www.acep.org\/globalassets\/new-pdfs\/policy-statements\/appropriate-use-criteria-for-handheld-pocket-ultrasound-devices.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13244-019-0775-x","article-title":"ESR statement on portable ultrasound devices","volume":"10","author":"Clevert","year":"2019","journal-title":"Insights Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e002257","DOI":"10.1136\/bmjopen-2012-002257","article-title":"Junior doctor skill in the art of physical examination: A retrospective study of the medical admission note over four decades","volume":"3","author":"Oliver","year":"2013","journal-title":"BMJ Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1093\/ehjci\/jet195","article-title":"The decline of our physical examination skills: Is echocardiography to blame?","volume":"15","author":"Roelandt","year":"2013","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1111\/j.1540-8175.2012.01728.x","article-title":"Diagnostic Performance of Handheld Echocardiography for the Assessment of Basic Cardiac Morphology and Function: A Validation Study in Routine Cardiac Patients","volume":"29","author":"Prinz","year":"2012","journal-title":"Echocardiography"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.mayocp.2013.12.016","article-title":"Diagnostic Capability of Comprehensive Handheld vs Transthoracic Echocardiography","volume":"89","author":"Cullen","year":"2014","journal-title":"Mayo Clin. Proc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1002\/clc.22754","article-title":"Handheld echocardiography during hospitalization for acute myocardial infarction","volume":"40","author":"Cullen","year":"2017","journal-title":"Clin. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/echo.14575","article-title":"Smartphone interfaced handheld echocardiography for focused assessment of ventricular function and structure in children: A pilot study","volume":"37","author":"Acheampong","year":"2019","journal-title":"Echocardiography"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4250\/jcvi.2020.0241","article-title":"Handheld Echocardiography in a Clinical Practice Scenario: Concordances Compared to Standard Echocardiographic Reports","volume":"30","author":"Blume","year":"2022","journal-title":"J. Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: The kappa statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1136\/heartjnl-2021-319561","article-title":"Diagnostic accuracy of handheld cardiac ultrasound device for assessment of left ventricular structure and function: Systematic review and meta-analysis","volume":"107","author":"Jenkins","year":"2021","journal-title":"Heart"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1093\/ehjci\/jey145","article-title":"The use of handheld ultrasound devices: A position statement of the European Association of Cardiovascular Imaging (2018 update)","volume":"20","author":"Cardim","year":"2018","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_29","unstructured":"(2022, October 11). Medgadget. Available online: https:\/\/www.medgadget.com\/2020\/09\/echonous-kosmos-3-in-1-ultrasound-electronic-stethoscope-and-ecg-helps-with-covid-19.html."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/ehjdh\/ztac001","article-title":"Clinical validation of an artificial intelligence-assisted algorithm for automated quantification of left ventricular ejection fraction in real time by a novel handheld ultrasound device","volume":"3","author":"Papadopoulou","year":"2022","journal-title":"Eur. Heart J.-Digit. Health"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/5\/853\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:40:09Z","timestamp":1760121609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/5\/853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,23]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["diagnostics13050853"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13050853","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,23]]}}}