Key result
Physician-performed focused cardiac ultrasound shows substantial agreement with echocardiography for detecting LV systolic impairment.
Why the study?
Accuracy of internal medicine physician-performed focused cardiac ultrasound (FoCUS) for assessing left ventricular systolic function requires independent evaluation compared with formal echocardiography.
Observational (n=178)
No
Effect estimate: κ = 0.77 (95% CI 0.67, 0.87)
p-value: p=<0.001
May support internist-performed focused cardiac ultrasound for inpatient LV assessment; extends ED/ICU data but leaves open need for randomized validation.
PURPOSE: Although focused cardiac ultrasonographic (FoCUS) examination has been evaluated in emergency departments and intensive care units with good correlation to formal echocardiography, accuracy for the assessment of left ventricular systolic function (LVSF) when performed by internal medicine physicians still needs independent evaluation. METHODS: This prospective observational study in a 640-bed, academic, quaternary care center, included 178 inpatients examined by 10 internal medicine physicians who had completed our internal medicine bedside ultrasound training program. The ability to estimate LVSF with FoCUS as "normal," "mild to moderately decreased," or "severely decreased" was compared with left ventricular ejection fraction (>50%, 31-49%, and <31%, respectively) from formal echocardiography interpreted by a cardiologist. RESULTS: Sensitivity and specificity of FoCUS for any degree of LVSF impairment were 0.91 (95% confidence interval [CI] 0.80, 0.97) and 0.88 (95% CI 0.81, 0.93), respectively. The interrater agreement between internal medicine physician-performed FoCUS and formal echocardiography for any LVSF impairment was "good/substantial" with κ = 0.77 (p < 0.001), 95% CI (0.67, 0.87). Formal echocardiography was classified as "technically limited due to patient factors" in 20% of patients; however, echogenicity was sufficient in 100% of FoCUS exams to classify LVSF. CONCLUSIONS: Internal medicine physicians using FoCUS identify normal versus decreased LVSF with high sensitivity, specificity, and "good/substantial" interrater agreement when compared with formal echocardiography. These results support the role of cardiac FoCUS by properly trained internal medicine physicians for discriminating normal from reduced LVSF.
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Tierney et al. (2015) conducted an observational in Left ventricular systolic function impairment (n=178). Focused cardiac ultrasonography (FoCUS) vs. Formal echocardiography was evaluated on Interrater agreement for any degree of left ventricular systolic function impairment (κ = 0.77, 95% CI 0.67, 0.87, p=<0.001). Internal medicine physician-performed focused cardiac ultrasonography demonstrated high sensitivity (0.91) and specificity (0.88), with substantial interrater agreement (κ = 0.77) for identifying left ventricular systolic function impairment compared to formal echocardiography.
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