By Megan Rauscher

NEW YORK (Reuters Health) — In patients with heart failure, clinical volume status can be rapidly and accurately determined by a non-expert at the bedside using a handheld Doppler echocardiography device and a simplified algorithm, a study indicates.

In comments to Reuters Health, study investigator Dr. Viviane T. Q. Nguyen, now at Royal Victoria Hospital, Montreal, Quebec, Canada, noted that "managing volume status is crucial in heart failure to improve symptoms of congestion and keep patients out of the hospital. The determination of volume status is often challenging in general practice settings."

"We devised a simplified echo algorithm, the TEC-HF, using well-described echo parameters, which was performed quickly at the bedside using a portable handheld echo machine," Dr. Nguyen explained.

According to a report in the American Heart Journal for September, Dr. Nguyen and colleagues recruited 100 consecutive heart failure patients (mean age, 60 years; mean left ventricular ejection fraction, 27%) to undergo bedside echocardiography performed by a medical resident with no previous cardiology or echocardiography experience who was trained for 10 hours in the new procedure. Subjects were assigned to 1 of 4 left-sided filling patterns: normal, abnormal relaxation, pseudonormal and restrictive.

The gold standard for determining elevated left-sided filling pressure was clinical evaluation by a heart failure specialist, who classified subjects as being euvolemic or hypervolemic.

Observations using the TEC-HF algorithm with handheld echocardiography "compared favorably to the assessment by a certified heart failure specialist," Dr. Nguyen reported.

Based on the algorithm, pseudonormal and restrictive filling patterns predicted hypervolemia, and normal and abnormal relaxation patterns predicted euvolemia, with sensitivity of 86%, specificity of 92%, positive predictive value of 86%, and negative predictive value of 92%.

"Moreover, it was easily taught and performed by non-expert medical staff with very limited echo training who obtained adequate images in all patients," Dr. Nguyen said.

"In the future, handheld echocardiography may be a useful tool in the assessment of volume status in heart failure patients in the community, where most heart failure patients will receive their care," Dr. Nguyen and colleagues conclude in their report.

Am Heart J 2008;156:537-542.

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