Accuracy of Echocardiography in the Emergency Medicine Department

ABSTRACT

PURPOSE: At the Emergency Department (ED), echocardiography of patients with chest pain, dyspnea, and syncope is essential to identify the underlying etiology such as acute coronary diseases or other cardiac diseases. Therefore, we studied the accuracy and the clinical value of echocardiography for use by the emergency physician as a tool for the identification and evaluation of cardiac diseases. METHOD: From first, September, 2003 to first, November, 2003, we collected the case histories of 40 patients with suspected cardiac diseases, on whom formal echocardiography had been performed within 2 hours after their initial ED echocardiography. The emergency physicians had a 4-hour didactic training course by cardiologists and 1 month of practical training at a formal echocardiography center, then, they performed the echocardiography using an Acuson ASPENT M ultrasound system with a 3.5-MHz phased-array transducer. Data from the emergency physicians and from the formal echocardiographers were analyzed using the wilcoxson sign test, and the correlation coefficient and p value were calculated. RESULT: There were 28 male patients (70.0%) and 12 female patients (30.0%) and the average age of all patients was 60.9+/-15.5 years. The left ventricular end diastolic diameters (LVEDD) from ED and formal echocardiography were, respectively, 44.6+/-7.9 mm and 48.7+/-6.6 mm (p=0.000), the interventricular septum thicknesses (IVS) were 11.6+/-3.6 mm and 10.9+/-3.0 mm (p=0.064), the left ventricular posterior wall thicknesses (LVPW) were 10.9+/-3.4 mm and 10.1+/-2.00 mm (p=0.178), the ejection fractions (EF) were 59.7+/-15.8% and 60.0+/-16.4%(p=0.312), the left atrium diameters were 36.5+/-6.3 mm and 37.0+/-5.8 mm (p=0.770), the aortic root diameters were 29.2+/-4.0 mm and 33.6+/-3.7 mm (p=0.001), and the inferior vena cava diameters (IVC) were 15.9+/-8.1 mm and 13.3+/-2.5 mm (p=0.444). Except for the LVEDD and the aortic root diameters, there were no significant differences between ED and formal echocardiography, and the presences of regional wall motion abnormalities (RWMA), relaxation abnormalities, right atrium enlargement (RAE), and right ventricle abnormalities were all concordant between the two groups. The correlation coefficients and the p values between ED and formal echocardiography were, respectively, 0.806 and 0.000 for LVEDD, 0.662 and 0.000 for IVS thickness, 0.725 and 0.000 for LVPW thickness, 0.922 and 0.000 for EF, 0.729 and 0.001 for left atrium diameter, 0.331 and 0.037 for aortic root diameter, and 0125 and 0.443 for IVS diameter. CONCLUSION: We suggest that ED echocardiography, like formal echocardiography, with additional focused training can measure and assess the structural and the functional parameters of the heart.