title: An alternative approach to the bedside assessment of left ventricular systolic function in the emergency department: displacement of the aortic root.
abstract: OBJECTIVE
  Left ventricular ejection fraction (LVEF) is a crucial parameter in the management of patients with dyspnea in the emergency department (ED). The use of techniques other than echocardiography such as nuclear or magnetic resonance imaging to measure LVEF is unsuitable in the ED because of time constraints. This study aimed to compare echocardiographic aortic root (AR) excursion and LVEF measurement using the modified Simpson's method (biplane method of disks) as recommended by the American Society of Echocardiography.
  
  
  METHODS
  After 2 hours of theoretical video and hands-on training with 20 patients by an experienced echocardiographer, two emergency physicians prospectively evaluated patients with dyspnea. Two-dimensional echocardiograms of the parasternal long-axis view were obtained, and the displacement of the aortic root (DAR) was studied. M-mode DAR recordings were obtained, and distances were measured as the maximized anterior displacement of the AR from the horizontal axis at end-systole by using the leading-edge methodology. LVEF was measured by an experienced cardiologist using the modified Simpson's rule. The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-), and positive and negative predictive values (PPV, NPV) were analyzed. A new formula for the prediction of the ejection fraction (EF) with the aid of DAR was then created.
  
  
  RESULTS
  The mean (±SD) age with of the 70 study patients was 69.7 (±11.91) years. In these patients, DAR was highly correlated with EF (point biserial correlation coefficient = 0.79, p < 0.001) and one-way analysis of variance (ANOVA) results were significant (F = 115.9; p < 0.001). The sensitivity was 94.4; specificity, 94.1; LR+, 16.6; LR-, 0.059; PPV, 94.4; and NPV, 94.1.
  
  
  CONCLUSIONS
  The results indicate that DAR is a sensitive index of left ventricular systolic function (SF) and can be used to reliably predict EF values using the rough formula of EF = 20 + 44 (DAR).
authors.affiliation: Department of Emergency Medicine, Izmir Ataturk Research and Training Hospital, Izmir, Turkey. erolerdenun@yahoo.com
authors.forename: Erden Erol
authors.initials: EE
authors.lastname: Ünlüer
authors.forename: Arif
authors.initials: A
authors.lastname: Karagöz
authors.forename: Serdar
authors.initials: S
authors.lastname: Bayata
authors.forename: Haldun
authors.initials: H
authors.lastname: Akoğlu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001011:Aorta / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology*; D019560:Echocardiography, Three-Dimensional; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis; D019095:Point-of-Care Systems; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013599:Systole / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*