title: Determination of left ventricular function by emergency physician echocardiography of hypotensive patients.
abstract: OBJECTIVE
  To determine whether emergency physicians (EPs) with goal-directed training can use echocardiography to accurately assess left ventricular function (LVF) in hypotensive emergency department (ED) patients.
  
  
  METHODS
  Prospective, observational study at an urban teaching ED with >100,000 visits/year. Four EP investigators with prior ultrasound experience underwent focused echocardiography training. A convenience sample of 51 adult patients with symptomatic hypotension was enrolled. Exclusion criteria were a history of trauma, chest compressions, or electrocardiogram diagnostic of acute myocardial infarction. A five-view transthoracic echocardiogram was recorded by an EP investigator who estimated ejection fraction (EF) and categorized LVF as normal, depressed, or severely depressed. A blinded cardiologist reviewed all 51 studies for EF, categorization of function, and quality of the study. Twenty randomly selected studies were reviewed by a second cardiologist to determine interobserver variability.
  
  
  RESULTS
  Comparison of EP vs. primary cardiologist estimate of EF yielded a Pearson's correlation coefficient R = 0.86. This compared favorably with interobserver correlation between cardiologists (R = 0.84). In categorization of LVF, the weighted agreement between EPs and the primary cardiologist was 84%, with a weighted kappa of 0.61 (p < 0.001). Echocardiographic quality was rated by the primary cardiologist as good in 33%, moderate in 43%, and poor in 22%. The EF was significantly lower in patients with a cardiac cause of hypotension vs. other patients (25 +/- 10% vs. 48 +/- 17%, p < 0.001).
  
  
  CONCLUSIONS
  Emergency physicians with focused training in echocardiography can accurately determine LVF in hypotensive patients.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Moore
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Rose
authors.forename: Vivek S
authors.initials: VS
authors.lastname: Tayal
authors.forename: D Matthew
authors.initials: DM
authors.lastname: Sullivan
authors.forename: James A
authors.initials: JA
authors.lastname: Arrowood
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004452:Echocardiography / Q000379:methods; D004635:Emergency Medicine / Q000193:education / Q000379:methods*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*