Can Junior Emergency Physicians Use E-Point Septal Separation to Accurately Estimate Left Ventricular Function in Acutely Dyspneic Patients?

Abstract

Objectives: The authors determined if E-point septal separation (EPSS) as measured by junior emergency physicians (EPs) correlated with visual estimation of left ventricle ejection fraction (LVEF) by senior EPs and cardiologists in acutely dyspneic patients presenting to an adult emergency department (ED).Methods: Acutely dyspneic patients were enrolled in a prospective, observational study. EPSS was measured using bedside ultrasonography by junior EPs (PGY 3 and PGY 4 residents) with variable ultrasound experience. M-mode measurements of EPSS were recorded in the parasternal long-axis orientation and were calculated during diastole by measuring distance from the tip of the anterior mitral valve leaflet to the septal wall. LVEF was visually estimated at the bedside by emergency medicine (EM) ultrasound fellows and an EM ultrasound fellowship-trained attending physician and was subsequently visually estimated by two cardiologists reviewing video clips obtained by the junior EPs. The correlation between EPSS and visually estimated LVEF was calculated.Results: Of the 58 patients, the median age was 63 years (range = 28 to 90 years) and 66% were women. Interobserver reliability between EPs and cardiologists for the visual estimation of LVEF was excellent (j = 0.75). The correlation between measurements of EPSS by junior EPs and visual estimations of LVEF by the senior EPs was q = )0.844 (p < 0.001).Conclusions: In this study, junior EPs were able to obtain measurements of EPSS that correlated closely with visual estimates of LVEF by clinicians with extensive point-of-care and comprehensive echocardiography experience.

E-Point Septal Separation Compared to Fractional Shortening Measurements of Systolic Function in Emergency Department Patients

“…Our findings are not markedly different from the data shown in the study by Secko et al, 16 in which there was a noticeable range of E-point septal separation measurements obtained at specific levels of the visually estimated EF.…”

“…It is frequently used in veterinary medicine but is infrequently used in humans to detect poor systolic function despite positive reports of its accuracy. [10][11][12][13][14][15] A recent study by Secko et al 16 of point-of-care cardiac sonography of ED patients with dyspnea compared bedside E-point septal separation measurements performed by junior emergency medicine residents with visually estimated EF values by experienced emergency physicians. In the above-mentioned study, a significant correlation (-0.84; P < .001) was found between E-point septal separation and later visual estimations of the EF.…”

Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol

“…Studies have demonstrated that EPSS greater than 1 cm reliably correlates with a low ejection fraction [35]. Another study demonstrated that Emergency Physicians are able to accurately estimate ejection fraction using EPSS [36], highlighting its value in identifying patients with abnormal contractility. An important caveat is that EPSS does not reflect systolic dysfunction in the setting of mitral valve abnormalities (stenosis, regurgitation), aortic regurgitation, or extreme left ventricle hypertrophy.…”

First “Glass” Education: Telementored Cardiac Ultrasonography Using Google Glass‐ A Pilot Study

“…EF is calculated using M-mode to measure the approximation of the anterior leaflet of the mitral valve to the septum during the early filling phase of diastole. 6 Participants were tasked to acquire PSLA cardiac images through different models of education on a single test, 75-kg live model. Prior to randomization, all students were given 3 minutes of live instruction on the use of Google Glass, as well as the basic functionality of GE Vscan.…”