Assessment of left ventricular ejection fraction by the emergency physician versus the cardiologist: A concordance study about 52 cases

Introduction : Transthoracic echocardiographic examination (TTE) that is performed at the patient’s bedside in emergency departments has several recognized important indications. Objective: The purpose of our study is to... [ view full abstract ]

Introduction : Transthoracic echocardiographic examination (TTE) that is performed at the patient’s bedside in emergency departments has several recognized important indications.
Objective: The purpose of our study is to evaluate the agreement of the estimates of left ventricular ejection fraction (LVEF) obtained by emergency physicians with the findings obtained by cardiologists in patients admitted to emergency departments.
Material and methods: This randomized prospective study was carried out in the emergency department over a period of 6 months, involving patients aged > 16 years whose condition required an emergency TTE.
The patients included in the study had to undergo a double echocardiographic examination: An initial investigation that was performed in the emergency department by an emergency physician who had previously received a three-month training in Doppler echocardiography.
A subsequent echocardiographic examination that was performed by an echo-Doppler proficient cardiologist.
Left ventricular ejection fraction was evaluated by both readers using the following methods: the global visual estimation (GVE) method, Teicholtz’s method in time movement mode (TM) and Simpson Biplan method (SB).
We excluded from the study patients with segmental kinetic disorders or with hearts out of alignment. The findings thus obtained were compared using the inter-class concordance coefficient of Cronbach’s alpha.
Results : Fifty-two patients were involved in the study. Mean age was 55 + 11 years; sex-ratio was 7 males/4 females.
For the GVE method, the findings obtained by the emergency physician were similar to those obtained by the cardiologist: alpha = 0.72 (IC 95% = [0.68-0.78]; p<10-3).
The findings obtained by both operators by Teicholtz’s method were as follows: alpha = 0.94 (IC 95% = [0.80-0.95]; p<10-3).
The concordance of the findings obtained by the emergency physician and of those obtained by the cardiologist for their assessment of LVEF by SB method was shown by alpha=0.91 (IC95% = [0.80 – 0.98]; p<10-3).
Conclusion : Global visual estimation of LVEF can be performed similarly by an emergency physician or by a cardiologist provided they are sufficiently experienced. The results yielded by both other methods (Teicholtz’s method and SB method) were very similar indicating an excellent concordance independently of the degree of deterioration of the left ventricle contractility. Biplan Simpson’s method is, however, a time-consuming procedure.

Key Words: left ventricular ejection fraction -emergency physician- cardiologist