Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure
1Department of Emergency Medicine, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey,
2Department of Emergency Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey,
3Department of Emergency Medicine, Mersin Toros State Hospital, Mersin,Turkey,
4Department of Emergency Medicine, Sivas Numune Hospital, Sivas, Turkey
Keywords: Echocardiography, emergency department, heart failure, ventricular ejection fractions (MesH Database)
OBJECTIVES: Although the reliability of e-point septal separation (EPSS) and caval index (CI) is proven in the diagnosis of acute heart failure (AHF), how much they contribute to the initial clinical impression is unclear. This study aimed to determine the diagnostic contribution of EPSS and CI to the initial clinical impression of AHF.
METHODS: This is a prospective observational study conducted in an academic emergency department (ED). The patients admitted to the ED with acute undifferentiated dyspnea were included. Primary diagnosis was made after an initial clinical evaluation, and a secondary diagnosis was made after EPSS and CI measurements. Independent cardiologists made the final diagnosis. The primary outcome was the diagnostic contribution of EPSS and CI to the primary diagnosis.
RESULTS: A total of 182 patients were included in the study. The primary diagnosis was found with a sensitivity of 0.55 and specificity of 0.84 and the secondary diagnosis was determined with a sensitivity of 0.78 and specificity of 0.83 in predicting the final diagnosis. The agreement coefficient between the primary and final diagnosis was 0.44 and between the secondary diagnosis and the final diagnosis was 0.61. When the primary diagnosis was coherent with secondary diagnosis, sensitivity and specificity were found to be 0.74 and 0.90, respectively.
CONCLUSION: Although a detailed history and physical examination are the essential factors in shaping clinical perception, CI and EPSS combined significantly contribute to the initial clinical impression.
How to cite this article: Duyan M, Ünal AY, Özturan IU, Günsoy E. Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure. Turk J Emerg Med 2020;20:105-10.
Institutional review board approval was obtained from the Akdeniz University Board of Ethics on Non-invasive Clinical Human Studies Ethics Committee (Date:25.11.2015, Number: 343).
M.D and A.Y.E contributed to conception; M.D and A.Y.E contributed to design; A.Y.E contributed to supervision; M.D and A.Y.E, and E.G contributed to data collection and processing; M.D and A.Y.E., and I.U.O. contributed to analysis and interpretation; E.G., and I.U.O. contributed to literature review; E.G. and I.U.O. contributed to writing; and M.D, A.Y.E., I.U.O., and E.G. contributed to critical review.