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Role of open access echocardiography in detection of cardiac structural and functional abnormalities
  1. Jason Chai1,
  2. Hasan Mohiaddin1,
  3. Amit K J Mandal1,
  4. Jasmine Gan1,
  5. Trisha Hirani1,
  6. Radhika Sholapurkar1,
  7. Constantinos G Missouris1,2
  1. 1Department of Medicine and Cardiology, Wexham Park Hospital, Slough, UK
  2. 2Department of Cardiology, University of Nicosia Medical School, Nicosia, Cyprus
  1. Correspondence to Professor Constantinos G Missouris, Frimley Health NHS Trust, Slough, SL2 4HL, UK; dinos.missouris{at}


Purpose To evaluate the prevalence and incidence of significant structural heart disease in targeted patients with cardiac symptoms referred by general practitioners (GPs) using open access echocardiography, without prior clinical evaluation by a cardiologist.

Design Data were derived from 488 subjects who underwent transthoracic echocardiography between January and April 2018. Patients were referred directly by GPs in East Berkshire, South England, through an online platform. Echocardiography was performed within 4–6 weeks of referral and all reports were assessed by a consultant cardiologist with expedited follow-up facilitated pro re nata. Results were analysed to determine the frequency of detection of structural abnormalities, particularly of the left ventricle and cardiac valves.

Results Echocardiography was prospectively performed in consecutive subjects (50% male, mean (±SD) age 68.5±22 years; 50% female; mean (±SD) 64.6 (±19.1)). At least one abnormality likely to change management was found in 133 (27.3%) of all open access echocardiograms. Clinical heart failure with left ventricular systolic dysfunction (LVSD) and diastolic dysfunction was confirmed in 46 (9%) and 69 (14%), respectively. Of the 46 patients with LVSD, 33 were new diagnoses. Significant cardiac valve disease was found in 42 (8.6%) patients. 12 of these had known valvular disease or previous valvular surgery, and 30 were new diagnoses.

Conclusion Major structural and functional cardiac abnormalities are common in late middle-aged patients who present to GPs with cardiac symptoms and signs. Reported, unrestricted open access echocardiography enables early detection of significant cardiac pathology and timely intervention may improve cardiovascular outcomes.

  • echocardiography
  • primary care
  • valvular heart disease
  • heart failure

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • JC and HM are joint first authors.

  • Contributors All seven authors contributed to the manuscript. All were involved in the design of the study. JC, HM, JG, TH and RS collected the data. HM and JC were responsible for the analysis. HM, JC, AKJM and CGM wrote the manuscript and all authors were involved in the final approval of the manuscript. AKJM and CGM are acting as guarantors of the submitted work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.