Real-world validation of a handheld ultrasound device with continuous Doppler capability in patients undergoing transcatheter aortic valve implantation

Purpose The use of hand-held ultrasound devices (HHUD) is expanding in clinical practice, yet the there is no evidence regarding their role in evaluating transcatheter aortic valve implantation (TAVI). This study assessed the concordance between measurements obtained using an HHUD with continuous wave Doppler (CW) capability and a reference ultrasound system in patients with TAVI prostheses. Methods A prospective, single-centre observational study was conducted in patients with TAVI prostheses. Following a reference echocardiogram by an expert operator, a second blinded evaluation was performed using a HHUD (Kosmos™, EchoNous) with CW Doppler by an intermediate-experience operator. Key valvular parameters were assessed with CW Doppler, and concordance with the reference was evaluated using intraclass correlation coefficient (ICC), linear regression, and Bland-Altman analysis. Results A total of 64 patients were included after excluding 3 (4.5%) due to measurement difficulties with the HHUD. The mean age was 81 years, with 63% being female. Balloon-expandable TAVI accounted for 79,7% of cases, while 20,3% were self-expanding. The HHUD showed good-to-excellent agreement with the reference TTE in the main 4 parameters of valve function: Mean transvalvular gradient (ICC = 0.76), maximum aortic velocity (ICC = 0.83), transvalvular velocity time integral (VTI) (ICC = 0.87) and left ventricle outflow tract VTI (ICC = 0.8). The agreement was good in the remaining echocardiographic measurements. Conclusions A HHUD with continuous wave Doppler capability showed good concordance with standard echocardiography in patients with TAVI, even when used by operators with intermediate experience.