IngentaConnect Determination of Left Ventricular Function by Emergency Physician...

Authors: Moore, Christopher L.; Rose, Geoffrey A.¹; Tayal, Vivek S.¹; Sullivan, D. Matthew¹; Arrowood, James A.²; Kline, Jeffrey A.

Source: Academic Emergency Medicine, Volume 9, Number 3, March 2002 , pp. 186-193(8)

Publisher: Blackwell Publishing

Abstract:

Objective: To determine whether emergency physicians (EPs) with goal-directed training can use echocardiography to accurately assess left ventricular function (LVF) in hypotensive emergency department (ED) patients. Methods: Prospective, observational study at an urban teaching ED with >100,000 visits/year. Four EP investigators with prior ultrasound experience underwent focused echocardiography training. A convenience sample of 51 adult patients with symptomatic hypotension was enrolled. Exclusion criteria were a history of trauma, chest compressions, or electrocardiogram diagnostic of acute myocardial infarction. A five-view transthoracic echocardiogram was recorded by an EP investigator who estimated ejection fraction (EF) and categorized LVF as normal, depressed, or severely depressed. A blinded cardiologist reviewed all 51 studies for EF, categorization of function, and quality of the study. Twenty randomly selected studies were reviewed by a second cardiologist to determine interobserver variability. Results: Comparison of EP vs. primary cardiologist estimate of EF yielded a Pearson's correlation coefficient R = 0.86. This compared favorably with interobserver correlation between cardiologists (R = 0.84). In categorization of LVF, the weighted agreement between EPs and the primary cardiologist was 84%, with a weighted kappa of 0.61 (p < 0.001). Echocardiographic quality was rated by the primary cardiologist as good in 33%, moderate in 43%, and poor in 22%. The EF was significantly lower in patients with a cardiac cause of hypotension vs. other patients (25 ± 10% vs. 48 ± 17%, p < 0.001). Conclusions: Emergency physicians with focused training in echocardiography can accurately determine LVF in hypotensive patients.

Keywords: echocardiography; ejection fraction; emergency medicine; hypotension; shock; ultrasound

Document Type: Research article

DOI: 10.1197/aemj.9.3.186

Affiliations: 1: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 2: Department of Emergency Medicine, Medical College of Virginia Commonwealth University, Richmond, VA.

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Determination of Left Ventricular Function by Emergency Physician Echocardiography of Hypotensive Patients