Cardiovascular Ultrasound Combined With Non-invasive Screening for the Detection of Undiagnosed Cardiovascular Disease: A Literature Review

Non-invasive screenings have been widely utilized in the United States and worldwide to provide early identification of cardiovascular disease, allowing for earlier diagnosis and treatment. Screening sonography detects valve disease, cardiac dysfunction, and carotid disease in 5% to 20% of the population. This review discusses the current data regarding cardiovascular screening, the methodologies, and the resources required for performance of screenings. Cardiac and carotid sonography is highly accurate and discovers cardiovascular diseases that impact quality of life and risk of future events. Screenings are performed in a variety of settings and accuracy depends on the quality of personnel performing the non-invasive testing, the equipment utilized, and the personnel interpreting the studies. Despite the potential benefit for disease detection, population screening to detect cardiovascular disease is not widely supported by national organizations due to the theoretical cost of further testing and lack of cost versus benefit data. Additional studies are necessary to compare costs and benefits of non-invasive cardiovascular screening in the community setting.

[1]  C. Reid,et al.  SCReening Evaluation of the Evolution of New Heart Failure Study (SCREEN-HF): early detection of chronic heart failure in the workplace. , 2017, Australian health review : a publication of the Australian Hospital Association.

[2]  G. Lip,et al.  Ethnic differences in the prevalence of peripheral arterial disease: a systematic review and meta-analysis , 2017, Expert review of cardiovascular therapy.

[3]  S. Alladi,et al.  Prevalence and risk factors of asymptomatic carotid artery stenosis in Indian population: An 8-year follow-up study , 2017, Neurology India.

[4]  G. Boriani,et al.  Atrial fibrillation burden and atrial fibrillation type: Clinical significance and impact on the risk of stroke and decision making for long-term anticoagulation. , 2016, Vascular pharmacology.

[5]  E. Mtui,et al.  Silent Brain Infarction in Patients With Asymptomatic Carotid Artery Atherosclerotic Disease. , 2016, Journal of vascular surgery.

[6]  P. Okin,et al.  Community Screening for Nonischemic Cardiomyopathy in Asymptomatic Subjects ≥65 Years With Stage B Heart Failure. , 2016, The American journal of cardiology.

[7]  H. Kamel,et al.  Silent Brain Infarction in Patients With Asymptomatic Carotid Artery Atherosclerotic Disease , 2016, Stroke.

[8]  H. Dalen,et al.  Feasibility and reliability of pocket-size ultrasound examinations of the pleural cavities and vena cava inferior performed by nurses in an outpatient heart failure clinic , 2015, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[9]  Jonathan A Drezner,et al.  The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. , 2015, Journal of electrocardiology.

[10]  Catherine Webb,et al.  The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study. , 2015, European heart journal cardiovascular Imaging.

[11]  J. Prutkin,et al.  Modern standards of ECG interpretation in young athletes: yield and effectiveness. , 2015, Journal of electrocardiology.

[12]  C. Sable,et al.  Handheld Echocardiography Versus Auscultation for Detection of Rheumatic Heart Disease , 2015, Pediatrics.

[13]  Mario J. Garcia,et al.  Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. , 2015, Journal of the American College of Cardiology.

[14]  B. Yankaskas,et al.  The influence of mammographic technologists on radiologists' ability to interpret screening mammograms in community practice. , 2015, Academic Radiology.

[15]  K. George,et al.  Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia , 2015, European journal of preventive cardiology.

[16]  S. Shin,et al.  Vascular disease prevalence and risk factors in a screened Korean male population. , 2015, Annals of vascular surgery.

[17]  M. Björck,et al.  Update on screening for abdominal aortic aneurysm: a topical review. , 2014, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[18]  C. Sable,et al.  Simplified rheumatic heart disease screening criteria for handheld echocardiography. , 2014, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[19]  F. Rutten,et al.  Unrecognized Heart Failure and Chronic Obstructive Pulmonary Disease (COPD) in Frail Elderly Detected Through a Near-Home Targeted Screening Strategy , 2014, The Journal of the American Board of Family Medicine.

[20]  M. LeFevre Screening for asymptomatic carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement. , 2014, Annals of internal medicine.

[21]  M. LeFevre,et al.  Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement. , 2014, Annals of internal medicine.

[22]  G. Moretto,et al.  Yield of ultra-rapid carotid ultrasound and stroke specialist assessment in patients with TIA and minor stroke: an Italian TIA service audit , 2014, Neurological Sciences.

[23]  A. V. Van rij,et al.  Evaluation of the accuracy of aorta scan BVI 9600 in screening for abdominal aortic aneurysm. , 2014, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[24]  Janusz Wnek,et al.  2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[25]  J. Prutkin,et al.  Cardiovascular screening in adolescents and young adults: a prospective study comparing the Pre-participation Physical Evaluation Monograph 4th Edition and ECG , 2014, British Journal of Sports Medicine.

[26]  R. Holle,et al.  Should health insurers target prevention of cardiovascular disease?: a cost-effectiveness analysis of an individualised programme in Germany based on routine data , 2014, BMC Health Services Research.

[27]  M. Kanter,et al.  Leveraging the electronic medical record to implement an abdominal aortic aneurysm screening program. , 2014, Journal of vascular surgery.

[28]  M J Buxton,et al.  Cost-effectiveness of the National Health Service abdominal aortic aneurysm screening programme in England , 2014, The British journal of surgery.

[29]  L. Diller,et al.  Routine Echocardiography Screening for Asymptomatic Left Ventricular Dysfunction in Childhood Cancer Survivors: A Model-Based Estimation of the Clinical and Economic Effects , 2014, Annals of Internal Medicine.

[30]  G. Lyman,et al.  Cost-Effectiveness of the Children's Oncology Group Long-Term Follow-up Screening Guidelines for Childhood Cancer Survivors at Risk for Treatment-Related Heart Failure , 2014, Annals of Internal Medicine.

[31]  M. Björck,et al.  Screening for abdominal aortic aneurysm in 65-year-old men remains cost-effective with contemporary epidemiology and management. , 2014, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[32]  E. Whitlock,et al.  Ultrasonography Screening for Abdominal Aortic Aneurysms: A Systematic Evidence Review for the U.S. Preventive Services Task Force , 2014, Annals of Internal Medicine.

[33]  O. Franco,et al.  Predictive Value of Updating Framingham Risk Scores with Novel Risk Markers in the U.S. General Population , 2014, PloS one.

[34]  D. Gladstone,et al.  Screening for undiagnosed atrial fibrillation in the community , 2014, Current opinion in cardiology.

[35]  J. Pell,et al.  Ethnic differences in the cost-effectiveness of targeted and mass screening for high cardiovascular risk in the UK: cross-sectional study , 2013, Heart.

[36]  E. Mathiesen,et al.  Echocardiographic screening of the general population and long-term survival: a randomized clinical study. , 2013, JAMA internal medicine.

[37]  V. Moyer Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle–Brachial Index in Adults: U.S. Preventive Services Task Force Recommendation Statement , 2013, Annals of Internal Medicine.

[38]  M J Buxton,et al.  Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness. , 2013, Health technology assessment.

[39]  L. Zühlke,et al.  Echocardiographic screening for rheumatic heart disease: issues for the cardiology community. , 2013, Global heart.

[40]  Daniel J. Bertges,et al.  Optimal selection of asymptomatic patients for carotid endarterectomy based on predicted 5-year survival. , 2013, Journal of vascular surgery.

[41]  S. Kobal,et al.  Briefly Trained Medical Students Can Effectively Identify Rheumatic Mitral Valve Injury Using a Hand‐Carried Ultrasound , 2013, Echocardiography.

[42]  H. Dalen,et al.  Feasibility and reliability of point-of-care pocket-size echocardiography performed by medical residents , 2013, European heart journal cardiovascular Imaging.

[43]  H. Krum,et al.  Early identification of asymptomatic subjects at increased risk of heart failure and cardiovascular events: progress and future directions. , 2013, Heart, lung & circulation.

[44]  S. Viskin,et al.  Preventing sudden death of athletes with electrocardiographic screening: what is the absolute benefit and how much will it cost? , 2012, Journal of the American College of Cardiology.

[45]  Nikola Bogunovic,et al.  The importance of training in echocardiography: a validation study using pocket echocardiography , 2012, Journal of cardiovascular medicine.

[46]  J. Drezner,et al.  Cardiac screening: time to move forward! , 2012, British Journal of Sports Medicine.

[47]  V. Moyer,et al.  Screening for Coronary Heart Disease With Electrocardiography: U.S. Preventive Services Task Force Recommendation Statement , 2012, Annals of Internal Medicine.

[48]  K. McDonald,et al.  Screening to prevent heart failure (STOP‐HF): expanding the focus beyond asymptomatic left ventricular systolic dysfunction , 2012, European journal of heart failure.

[49]  T. Pearson,et al.  Carotid endarterectomy and carotid artery stenting utilization trends over time , 2012, BMC Neurology.

[50]  E. Ashley,et al.  Interpretation of the Electrocardiogram of Young Athletes , 2011, Circulation.

[51]  C. W. Cole,et al.  Screening Carotid Artery Duplex in Patients Undergoing Cardiac Surgery , 2011 .

[52]  A. Go,et al.  Ankle brachial index screening in asymptomatic older adults. , 2011, American heart journal.

[53]  Warren J Manning,et al.  ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, , 2011, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[54]  Jens-Uwe Voigt,et al.  Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. , 2011, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[55]  Woo Kyung Moon,et al.  Breast cancers initially detected by hand-held ultrasound: detection performance of radiologists using automated breast ultrasound data , 2011, Acta radiologica.

[56]  Zahi A Fayad,et al.  2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2010, Circulation.

[57]  G. de Simone,et al.  Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study , 2010, Cardiovascular ultrasound.

[58]  S. Shin,et al.  Prevalence and Characteristics of Major Vascular Diseases of Elderly Men in the Incheon Area , 2010 .

[59]  J. Atherton,et al.  Screening for left ventricular systolic dysfunction: is imaging a solution? , 2010, JACC. Cardiovascular imaging.

[60]  E. Ashley,et al.  Cost-Effectiveness of Preparticipation Screening for Prevention of Sudden Cardiac Death in Young Athletes , 2010, Annals of Internal Medicine.

[61]  S. Berger,et al.  Current Controversies in the Cardiovascular Screening of Athletes , 2010, Current sports medicine reports.

[62]  R. Todd Hurst,et al.  Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis. , 2009, Mayo Clinic proceedings.

[63]  P. Rahko,et al.  The 5-minute screening echocardiogram for athletes. , 2008, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[64]  T. Best,et al.  Electrocardiograms in athletes: interpretation and diagnostic accuracy. , 2008, Medicine and science in sports and exercise.

[65]  Salim Yusuf,et al.  Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W Substudy. , 2007, Journal of the American College of Cardiology.

[66]  C. Coletta,et al.  Reliability of cardiac dimensions and valvular regurgitation assessment by sonographers using hand-carried ultrasound devices. , 2006, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[67]  A. Waggoner,et al.  American Society of Echocardiography minimum standards for the cardiac sonographer: a position paper. , 2006, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[68]  B. Maron,et al.  Medical and legal issues in the cardiovascular evaluation of competitive athletes. , 2005, JAMA.

[69]  R. Senior,et al.  Cost-effective strategies to screen for left ventricular systolic dysfunction in the community--a concept. , 2005, Congestive heart failure.

[70]  Sonia S. Anand,et al.  Sensitivity and Specificity of the Ankle–Brachial Index to Predict Future Cardiovascular Outcomes: A Systematic Review , 2005, Arteriosclerosis, thrombosis, and vascular biology.

[71]  P. Sheehan,et al.  Peripheral Arterial Disease in People With Diabetes: Consensus Statement Recommends Screening , 2004 .

[72]  Masood Ahmad,et al.  Rapid screening of cardiac patients with a miniaturized hand‐held ultrasound imager‐comparisons with physical examination and conventional two‐dimensional echocardiography , 2004, Clinical cardiology.

[73]  P. Vignon,et al.  Hand-held echocardiography with doppler capability for the assessment of critically-ill patients: is it reliable? , 2004, Intensive Care Medicine.

[74]  C. Rockman,et al.  A model for predicting occult carotid artery stenosis: screening is justified in a selected population. , 2003, Journal of vascular surgery.

[75]  J. Bermejo,et al.  Portable spectral Doppler echocardiographic device: overcoming limitations , 2003, Heart.

[76]  R. Lang,et al.  The use of small personal ultrasound devices by internists without formal training in echocardiography. , 2003, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[77]  Jeroen J. Bax,et al.  Left ventricular hypertrophy screening using a hand-held ultrasound device. , 2002, European heart journal.

[78]  P. Wolf,et al.  Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. , 1987, Archives of internal medicine.

[79]  Kumar Narayanan,et al.  Screening for rheumatic heart disease: evaluation of a focused cardiac ultrasound approach. , 2015, Circulation. Cardiovascular imaging.

[80]  J. Kalman,et al.  Modest agreement in ECG interpretation limits the application of ECG screening in young athletes. , 2015, Heart rhythm.

[81]  Andrea Beaton,et al.  The utility of handheld echocardiography for early diagnosis of rheumatic heart disease. , 2014, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[82]  Haran Burri,et al.  Diagnostic accuracy of pocket-size handheld echocardiographs used by cardiologists in the acute care setting. , 2013, European heart journal cardiovascular Imaging.

[83]  童鸿 Recommendations for Interpretation of 12-lead Electrocardiogram in the Athlete , 2011 .

[84]  J. Bella,et al.  Point-of-care screening for left ventricular hypertrophy and concentric geometry using hand-held cardiac ultrasound in hypertensive patients. , 2011, American journal of cardiovascular disease.

[85]  J. Stockman,et al.  Cardiovascular Screening in College Athletes With and Without Electrocardiography: A Cross-sectional Study , 2011 .

[86]  Jeffrey L. Anderson,et al.  ACCF / AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults , 2010 .

[87]  R. Senior,et al.  Community screening for left ventricular hypertrophy in patients with hypertension using hand-held echocardiography. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[88]  R. Rutherford,et al.  Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). , 2000, Journal of vascular surgery.