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April 21, 2022POCUS JournalOpen Access

E-Point Septal Separation Accuracy for the Diagnosis of Mild and Severe Reduced Ejection Fraction in Emergency Department Patients

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Why the study?

In the ED, thorough cardiovascular evaluation cannot be accomplished by physical examination alone, prompting evaluation of EPSS via POCUS to diagnose reduced LVEF.

Does E-Point Septal Separation (EPSS) measured by POCUS accurately diagnose reduced LVEF in ED patients with chest pain or dyspnea?

Comparison

POCUS EPSS measurement vs transthoracic echocardiogram

Design

Retrospective analysis of a convenience sample

Key result

E-Point Septal Separation measured via POCUS accurately diagnosed reduced left ventricular ejection fraction (≤40%) in emergency department patients, demonstrating an AUC-ROC of 0.91.

Authors

JNJosé Atilio Núñez-RamosMPMaría Camila Pana-TolozaSHSheyla Carolina Palacio Held

Discussion

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Overview

EPSS at 9.5 mm may aid bedside LVEF assessment in ED; leaves open prospective validation before clinical adoption.

Study Design

Type

Observational (n=96)

Blinding

Blinded (index and reference tests)

Multicenter

No

Structured PICO

Does E-Point Septal Separation (EPSS) measured by POCUS accurately diagnose reduced LVEF in ED patients with chest pain or dyspnea?

P
Population
96 adult emergency department patients presenting with chest pain or dyspnea, free of shock or cardiac arrest, who underwent both POCUS and formal transthoracic echocardiography.
E
Exposure
E-Point Septal Separation (EPSS) measurement through Point-of-Care Ultrasound (POCUS) performed by an Internal Medicine Specialist.
C
Comparator
Transthoracic Echocardiogram (TTE) reference standard.
O
Outcome
Diagnostic accuracy (AUC-ROC, sensitivity, specificity, likelihood ratios) for Left Ventricle Ejection Fraction <50% and ≤40%.surrogate

Main Result

Effect estimate: AUC-ROC 0.91 (95% CI 0.85-0.97)

EPSS measured by POCUS is a highly accurate tool for diagnosing reduced LVEF in emergency department patients presenting with cardiovascular symptoms.

Limitations

  • Small sample size
  • Only one ED Internist performed ultrasound evaluations
  • Only one cardiologist performed all transthoracic echocardiograms
  • Single-center study, reducing inference of results
  • Higher prevalence of reduced EF than other publications, limiting extrapolation
  • Retrospective analysis
  • Convenience sample

Cite This Study

Núñez-Ramos et al. (2022) conducted an observational in Chest pain or dyspnea with suspected left ventricular dysfunction (n=96). E-Point Septal Separation (EPSS) via Point-of-Care Ultrasound vs. Transthoracic Echocardiogram (TTE) LVEF calculation was evaluated on Diagnostic accuracy (AUC-ROC) of EPSS to predict reduced Ejection Fraction (LVEF ≤40%) (AUC-ROC 0.91, 95% CI 0.85-0.97). E-Point Septal Separation measured via POCUS accurately diagnosed reduced left ventricular ejection fraction (≤40%) in emergency department patients, demonstrating an AUC-ROC of 0.91.

synapsesocial.com/papers/6a3f1788777ec85f4a04adafhttps://doi.org/10.24908/pocus.v7i1.15220
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