P1051The use of remote-sensing robotic arm for telemedicine echocardiography: screening in rural areas

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Purpose: The aim of our study was to test a telemedicine echocardiographic application with a remote-sensing robotic arm for general population screening. A limited echocardiography (two-dimensional parasternal short and long axis views with M-mode) was performed by trained nurses in the general practices; examinations generally last 3 to 5 minutes.Method: The movements of the probe (2D movements on the chest, the rotation and the in/declinations) were registered simultaneously with the echo-video. The data were sent to the telemedicine internet server, where the pre- and post-processing were performed, which include image processing (image filtration, edge detection, deblurring and image enhancement, shape extraction and analysis, image segmentation, motion analysis, and optical flow analysis specifically designed to track the endocardial border) and the 3D reconstruction of the heart. The best 2D standard measurements were calculated from the 3D model, the rate of chamber dilatation and right/left ventricular hypertrophy were determined.Results: 234 subjects (age: 58.8+-9.4; m/f: 110/124; without known heart disease) were examined during the 15 months telemedicine screening period. 21 pts (8.97) were excluded because of poor registration. Left ventricular dilatation (LVD) were found in 17 pts (7.98%), left ventricular hypertrophy (LVH) in 39 pts (18.3%). Other diseases: aortic (N=16, 7.5%) (AoVD) mitral (N=9, 4.2%) (MVD) valve disease, HOCM (N=2, 0.93%), pericardial effusion (N=3, 1.4%) (PE). The standard echocardiographic examination in the cardiologic department were repeated in these patients (86 pts with these 107 pathologic findings). The positive predictive value for LVD was 0.93 (true positive (TP): 14, false positive (FP): 1); for LVH 0.91 (TP: 31, FP: 3). Agreement (kappa) between point-of-care echocardiography and standard echocardiography was 77% (0.29) for moderate or severe mitral regurgitation, 93% (0.33) for aortic valve thickening or immobility, and 97% (0.51) for moderate pericardial effusion.Conclusion: Identification of significant pathology by telemedicine echocardiography may be valuable and cost-effective when applied to the general population in remote areas, where the conventional echocardiography could not be performed.

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