McKaigney Conor J, Krantz Mori J, La Rocque Cherie L, Hurst Nicole D, Buchanan Matthew S, Kendall John L
Department of Emergency Medicine, Queen's University, Ontario, Canada; Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
Division of Cardiology, Denver Health Medical Center, Denver, CO; Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
Am J Emerg Med. 2014 Jun;32(6):493-7. doi: 10.1016/j.ajem.2014.01.045. Epub 2014 Feb 3.
Rapid assessment of left ventricular ejection fraction (LVEF) may be critical among emergency department (ED) patients. This study examined the predictive relationship between ED physician performed bedside mitral-valve E-point septal separation (EPSS) measurements to the quantitative, calculated LVEF. We further evaluated the relationship between ED physician visual estimates of global cardiac function (GCF) and calculated LVEF values.
A prospective observational study was conducted on a sequential convenience sample of patients receiving comprehensive transthoracic echocardiography (TTE). Three ED ultrasound fellows performed bedside ultrasound examinations to obtain both EPSS measurements and subjective visual GCF estimates. A linear regression analysis was conducted to examine the relation of EPSS to the calculated LVEF from the comprehensive TTE. Agreement (modified Cohen κ) between ED ultrasound fellow GCF estimates and the calculated LVEF was also assessed.
Linear regression analyses revealed a significant correlation (r=0.73, P<.001) between bedside EPSS and the calculated LVEF. The sensitivity and specificity of an EPSS measurement of greater than 7 mm for severe systolic dysfunction (LVEF≤30%) were 100.0% (95% confidence interval, 62.9-100.0) and 51.6% (95% confidence interval, 38.6-64.5), respectively. Subjective estimates of GCF were moderately correlated with calculated LVEF (Cohen κ=0.58).
Measurements of EPSS by ED physicians were significantly associated with the calculated measurements of LVEF from comprehensive TTE. Subjective visual estimates of GCF, however, demonstrated only moderate agreement with the calculated LVEF. An EPSS measurement greater than 7 mm was uniformly sensitive at identifying patients with severely reduced LVEF.
在急诊科患者中，快速评估左心室射血分数（LVEF）可能至关重要。本研究探讨了急诊科医生在床边进行的二尖瓣E点至室间隔距离（EPSS）测量与定量计算的LVEF之间的预测关系。我们还进一步评估了急诊科医生对整体心功能（GCF）的视觉估计与计算出的LVEF值之间的关系。
对接受全面经胸超声心动图（TTE）检查的患者进行连续便利抽样，开展一项前瞻性观察性研究。三名急诊科超声科住院医师进行床边超声检查，以获取EPSS测量值和主观视觉GCF估计值。进行线性回归分析，以检验EPSS与全面TTE计算出的LVEF之间的关系。还评估了急诊科超声科住院医师GCF估计值与计算出的LVEF之间的一致性（修正Cohen κ）。
线性回归分析显示，床边EPSS与计算出的LVEF之间存在显著相关性（r = 0.73，P <.001）。对于严重收缩功能障碍（LVEF≤30%），EPSS测量值大于7 mm时的敏感性和特异性分别为100.0%（95%置信区间，62.9 - 100.0）和51.6%（95%置信区间，38.6 - 64.5）。GCF的主观估计与计算出的LVEF呈中度相关（Cohen κ = 0.58）。
急诊科医生对EPSS的测量与全面TTE计算出的LVEF测量值显著相关。然而，GCF的主观视觉估计与计算出的LVEF仅显示出中度一致性。EPSS测量值大于7 mm在识别LVEF严重降低的患者时具有一致的敏感性。
