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

Abstract

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.

Relation of CHA2DS2 -VASc score with severity and complexity of coronary artery disease in patients with non-ST segment elevation myocardial infarction

“…12 These scoring systems generally include risks related to clinical history, physical exam, ECG, echocardiography findings and cardiac biomarkers. 12,13 Although they are very sensitive for ruling out low risk patients in the clinical settings; additional evaluation and/or interventions are required to predict cardiac adverse events in those with higher risk groups. 12,14 The SYNTAX is an angiographicbased scoring system that help clinicians to determine treatment strategies and prognosis in high-risk patients 3 .…”