Ana Maria Alguacil Muñoz

Atrial fibrillation (AF) is highly prevalent in internal medicine and often requires timely echocardiographic assessment. Limited availability of standard studies may delay management, particularly in acute or resource-limited settings. We conducted a multicenter, cross-sectional study across 35 Spanish hospitals, enrolling adults with new-onset or chronic AF without echocardiography in the previous 12 months, comparing internist-performed point-of-care ultrasound (POCUS) with blinded cardiologist-performed transthoracic or transesophageal echocardiography (TTE/TEE) as the reference standard. The primary outcome was diagnostic accuracy for structural abnormalities. Secondary outcomes included comparison with auscultation and the clinical impact of POCUS findings. Among 441 patients (mean age 80.4 ± 9.9 years; 51% women), POCUS showed good diagnostic accuracy for left ventricular (LV) dilation (sensitivity 83%, specificity 94%) and LV systolic dysfunction (sensitivity 81%, specificity 94%), and moderate accuracy for left atrial (LA) enlargement (sensitivity 91%, specificity 64%). Compared with auscultation, POCUS was significantly more accurate for detecting mitral and tricuspid disease. POCUS findings frequently prompted therapeutic adjustments, including anticoagulation in mitral stenosis, individualized rate-control strategies in LV dysfunction, diuretic titration in congestion, and referral for significant valvular disease. Pericardial effusion, though less common, strongly influenced management. Internist-performed POCUS demonstrated robust diagnostic performance in AF and directly informed bedside therapeutic decisions. Although it does not replace comprehensive echocardiography, particularly for detailed valvular assessment, it represents a valuable extension of the physical examination and may improve timely and equitable cardiac evaluation.

Background: In general, transthoracic echocardiography (TTE) is the first diagnostic test used for patients with bacteremia or candidemia and clinical signs of Infective Endocarditis (IE). Point-of-care ultrasound (POCUS) may be used in addition to physical examination for the detection of structural heart disease and valve abnormalities. Objective: To determine the diagnostic accuracy of POCUS for the detection of signs suggestive of IE, including vegetation, valvular regurgitation, structural heart disease, hepatomegaly, splenomegaly and septic embolisms, in patients with bacteremia or candidemia. Design: Observational, cross-sectional, multicenter study using convenience sampling. Setting: Six Spanish academic hospitals. Patients: Adult patients with bacteremia or candidemia between 1 February 2018 and 31 December 2020. Measurements: The reference test, to evaluate vegetation, valvular regurgitation and structural heart disease, was transesophageal echocardiography (TEE). For patients who did not undergo TEE, transthoracic echocardiography (TTE) was considered the reference test. POCUS was performed by internists, while conventional echocardiography procedures were performed by cardiologists. Results: In 258 patients, for the detection of valvular vegetation, POCUS had sensitivity, specificity, and positive and negative predictive values of 77%, 94%, 82% and 92%, respectively. For valvular regurgitation (more than mild), sensitivity was ≥76% and specificity ≥85%. Sensitivity values for the detection of hepatomegaly and splenomegaly were 92% and 92%, respectively, while those for specificity were 96% and 98%. Conclusion: POCUS could be a valuable tool, as a complement to physical examination, at the hospital bedside for patients with bacteremia or candidemia, helping to identify signs suggestive of IE.