Manu Sudhi, Vivek Gopinathan, Sanjan Asanaru Kunju, Ajay A, Nisarg S, Jayaraj Mymbilly Balakrishnan, Aishwarya T R, Khalid Mohammad, Chetana S
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576 104.
Department of Emergency Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India.
West J Emerg Med. 2025 Mar;26(2):191-199. doi: 10.5811/westjem.19394.
Assessing cardiac function is crucial for managing acute dyspnea. In this study we aimed to evaluate displacement of the aortic root (DAR) as a method for calculating ejection fraction (EF) in patients with undifferentiated dyspnea presenting to the emergency department (ED). The primary objective was to compare EF values obtained through DAR with the modified Simpson method, which is considered the criterion reference, within an Indian academic ED.
We conducted a prospective, cross-sectional study spanning two years (December 2019-December 2021). The study enrolled 110 consecutive ED patients ≥18 years of age, presenting with undifferentiated dyspnea and normal sinus rhythm. Ultrasound-trained investigators measured DAR using M-mode ultrasonography. Experienced echocardiographers, blinded to DAR, determined EF using the modified Simpson method. Statistical analyses included the Shapiro-Wilk test, McNemar test, and the receiver operating characteristic curve.
The mean DAR measurement was 0.781 centimeters, with an average calculated EF of 54.4%. The EF calculated using DAR did not differ significantly from EF calculated using the modified Simpson method. Comparative analysis revealed DAR's superior sensitivity (86.21%) compared to mitral annular plane systolic excursion (48.28%) and end-point septal separation (45.45%). The DAR method exhibited high accuracy (area under the curve = 0.958) with a cut-off value 0.706 (sensitivity 88.7%, specificity 93.1%).
Evaluating displacement of the aortic root to calculate ejection fraction in undifferentiated dyspnea demonstrated high accuracy, sensitivity, and agreement with the modified Simpson method, which is considered the criterion reference. Its simplicity and non-invasiveness makes it a valuable initial screening tool in emergency settings, with the potential to reshape cardiac assessment approaches and optimize patient care pathways in the ED.
评估心脏功能对于处理急性呼吸困难至关重要。在本研究中，我们旨在评估主动脉根部位移（DAR）作为急诊科（ED）中未分化呼吸困难患者计算射血分数（EF）的一种方法。主要目的是在印度一家学术性急诊科内，将通过DAR获得的EF值与被视为标准参考的改良Simpson法进行比较。
我们进行了一项为期两年（2019年12月至2021年12月）的前瞻性横断面研究。该研究纳入了110例年龄≥18岁、患有未分化呼吸困难且窦性心律正常的连续ED患者。经过超声培训的研究人员使用M型超声心动图测量DAR。对DAR不知情的经验丰富的超声心动图医生使用改良Simpson法确定EF。统计分析包括Shapiro-Wilk检验、McNemar检验和受试者操作特征曲线。
DAR的平均测量值为0.781厘米，计算出的平均EF为54.4%。使用DAR计算的EF与使用改良Simpson法计算的EF无显著差异。比较分析显示，与二尖瓣环平面收缩期位移（48.28%）和室间隔终点分离（45.45%）相比，DAR具有更高的敏感性（86.21%）。DAR方法表现出较高的准确性（曲线下面积 = 0.958），截断值为0.706（敏感性88.7%，特异性93.1%）。
在未分化呼吸困难中评估主动脉根部位移以计算射血分数显示出较高的准确性、敏感性，且与被视为标准参考的改良Simpson法具有一致性。其简单性和非侵入性使其成为急诊环境中有价值的初始筛查工具，有可能重塑心脏评估方法并优化急诊科的患者护理路径。
