Oral Abstracts - Monday

Page 1

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015

Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M01

A SIMPLIFIED APPROACH TO SCREEN FOR DIASTOLIC DYSFUNCTION USING LIMITED BEDSIDE ECHO BY EMERGENCY PHYSICIANS

J. Colla 1, P. Kotini-Shah 1, M. Del Rios 1, J. Briller 1, M. Gustafsson 1, N. Patel 1, H. Prendergast 1

1

University Of Illinois At Chicago, Department Of Emergency Medicine, Chicago, Usa

Background: Early detection of diastolic dysfunction is important and has potential for reversal. Emergency physicians (EPs) are well positioned to identify patients at risk for diastolic dysfunction early in the disease process and can improve the cardiovascular health of patients. However, identification of diastolic dysfunction (DD) is complex, multifactorial, and is limited due to time constraints in the ED. We explored a simplified method that could aid in screening for DD. Objective: To determine the accuracy of using only tissue doppler imaging (TDI) measurements as a means to detect DD when compared to a board certified cardiologist as a gold standard. Methods: A convenience sample of emergency department patients without signs or symptoms of heart failure were enrolled in a pilot study. Using limited bedside echo (LBE), TDI of the mitral annulus was recorded. The presence or absence of diastolic dysfunction was determined by the EP by taking the average peak velocities of the TDI septal (e’S )and lateral (e’L) measurements (e’A). If e’A was <9, then patient was considered to have LV diastolic dysfunction. A board certified cardiologist with ASE level III certification was given all data recorded from the LBE, regardless of the quality of images, to make a determination of diastolic dysfunction. The cardiologist read the study as either DD present, DD absent, or indeterminate. Indeterminates were classified as no DD. Results: 64 patients had LBEs performed. 17 studies were excluded due to incomplete data. 47 studies were sent to the cardiologist for reviews. Using (e’A), the sensitivity was 88.24% and specificity was 90.32%. The unweighted kappa score was 0.7753 (95% CI .589 to 0.9617). When the 7 indeterminates were excluded, 38 of out the 40 case were in agreement (kappa 0.896). The sensitivity remained the same and specificity increased to 100%. Conclusions: Our data suggests that using average of the TDI (e’A) has good strength of agreement, sensitivity, and specificity at determining DD when compared to the cardiologist’s interpretation. This simplified approach can serve as a one-step method of screening for LV diastolic dysfunction at the bedside.


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