The term “stethoscope” means “looking into the chest” in Greek. The advent of echocardiography has literally shown us that the term is a complete misnomer. The stethoscope allows us to listen to the heart (and hence should have been named “stethophone”), yet only with ultrasound can we actually see the heart. We can outline its anatomy and visualize intracavitary and transvalvular flows. We can assess its structure and function in real-time, dynamically, anywhere, and without the risks of ionizing radiation.
The last decades have therefore seen a staggering use of echocardiography, which has become the central imaging modality in cardiology. Its expanding application has taught us more about cardiac pathology and pathophysiology and – because of its risk-free repeatability – the naturally and interventionally occurring history of cardiac diseases. It is therefore not only best suited as a snapshot tool, to reach a one-time diagnosis, but also as the optimal tool to actively follow patients, identify potential changes in cardiac structure and function, assess the effect of therapy, evaluate prognosis, and risk-stratify.
The unleashed diagnostic capabilities of echocardiography have led to a decline in the use of the stethoscope and, frankly, in the skills of its use among a new generation of physicians.
However, costs, limited resources, and simply the size and weight of ultrasound machines, have so far not allowed to use echocardiography as frequently and ubiquitously as the stethoscope, which fits into every pocket and around everyone’s neck. This has initially led to a diagnostic gap at the point of care: Yes, an echo can provide more accurate and detailed information, but if it is not immediately available, and in parallel a decline in the use of the stethoscope and in the skills of its use occur, a dangerous diagnostic gap opens.
Fortunately, technological advances have led to mobile, portable, and finally hand-held devices that can be effectively employed at the point of care, not just to fill the described gap, but to bring the full diagnostic power of echocardiography whenever needed to the bedside: in the Emergency Room, the Intermediate Care Unit, the internal medicine ward, the outpatient clinic. Problem solved? Not really. One problem was solved, only to create another. Ultrasound has indeed moved from the diagnostic laboratory, remote from the point of care, directly to where it is immediately needed, yet by the same token, it has now also moved from the experienced echocardiography specialist evaluating high-quality images, acquired by a skilled sonographer, into the hands of the clinician with typically limited training. And it does so potentially at a critical diagnostic moment.
AISAP solves this problem. It empowers the clinician to perform, analyze, and interpret a comprehensive point-of-care echocardiographic study, document it, generate a report, safely store it, and retrieve it for review whenever needed. It is not equal in scope and content to that of a standard echocardiographic study on a high-end device; it is not meant to fulfill this role. However, it covers the full scope of questions that emerge at the bedside: Dimensions and function of left and right ventricular chambers, the atria, presence, and degree of valvular dysfunction and of pericardial fluid, size of the inferior vena cava. This approach allows the regular, standard assessments of 10 basic echocardiographic parameters within minutes, even in cases when just a focused question is asked and a very limited study is executed.
AISAP augments the technical and diagnostic skills of the clinician and – for the purpose of such a point-of-care study – can bring them to the level of the echocardiography expert. It saves time - and potentially patients - increasing diagnostic accuracy with high positive and negative predictive values. It may avoid superfluous tests, and hence costs, allocating the resources of the echocardiography laboratory more appropriately and efficiently.
It has been frequently said about the stethoscope that its most valuable component is what lies between the earpieces, because we need to understand what we hear. Similarly, in order to see, we need not only the “eyes” of a transducer, but also a brain. AISAP is such a brain, and hence augments ours. You only see what you look for. AISAP always actively looks, understands, and informs.
Professor Ehud Schwammenthal
Born in Israel. Training in Internal Medicine and Cardiology at the University Hospitals of Munster and Duesseldor, Research Fellowship in Cardiac Ultrasound at the Massachusetts General Hospital, Harvard Medical School (1992-1994). PhD in Cardiovascular Physiology (University of Muenster 1994). Since 1994 at Sheba Medical Center, Tel Hashomer. Between 2001 and 2003 Director of its Cardiac Outpatient Clinic and until 2012 Director of the Cardiac Rehabilitation Institute at Sheba and Associate Professor of Cardiology at Tel Aviv University. Founder and consulting CTO of Ventor Technologies (2003-2009). Founder and Chief Medical Officer Magenta Medical (since 2012). Past Co-Chair of the Innovation Committee of the European Association of Cardiovascular Imaging (EACVI).