Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in India
Introduction: Assessing cardiac function is crucial for managing acute dyspnea. In this study we aimed to evaluate displacement of the aortic root (DAR) as a method for calculating ejection fraction (EF) in patients with undifferentiated dyspnea presenting to the emergency department (ED). The prima...
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eScholarship Publishing, University of California
2025-02-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/8td4w610 |
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| author | Sudhi Manu Gopinathan Vivek Asanaru Kunju Sanjan A. Ajay S. Nisarg Mymbilly Balakrishnan Jayaraj T. R. Aishwarya Mohammad Khalid S. Chetana |
| author_facet | Sudhi Manu Gopinathan Vivek Asanaru Kunju Sanjan A. Ajay S. Nisarg Mymbilly Balakrishnan Jayaraj T. R. Aishwarya Mohammad Khalid S. Chetana |
| author_sort | Sudhi Manu |
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| description | Introduction: Assessing cardiac function is crucial for managing acute dyspnea. In this study we aimed to evaluate displacement of the aortic root (DAR) as a method for calculating ejection fraction (EF) in patients with undifferentiated dyspnea presenting to the emergency department (ED). The primary objective was to compare EF values obtained through DAR with the modified Simpson method, which is considered the criterion reference, within an Indian academic ED. Methods: We conducted a prospective, cross-sectional study spanning two years (December 2019–December 2021). The study enrolled 110 consecutive ED patients ≥18 years of age, presenting with undifferentiated dyspnea and normal sinus rhythm. Ultrasound-trained investigators measured DAR using M-mode ultrasonography. Experienced echocardiographers, blinded to DAR, determined EF using the modified Simpson method. Statistical analyses included the Shapiro-Wilk test, McNemar test, and the receiver operating characteristic curve. Results: The mean DAR measurement was 0.781 centimeters, with an average calculated EF of 54.4%. The EF calculated using DAR did not differ significantly from EF calculated using the modified Simpson method. Comparative analysis revealed DAR’s superior sensitivity (86.21%) compared to mitral annular plane systolic excursion (48.28%) and end-point septal separation (45.45%). The DAR method exhibited high accuracy (area under the curve = 0.958) with a cut-off value 0.706 (sensitivity 88.7%, specificity 93.1%). Conclusion: Evaluating displacement of the aortic root to calculate ejection fraction in undifferentiated dyspnea demonstrated high accuracy, sensitivity, and agreement with the modified Simpson method, which is considered the criterion reference. Its simplicity and non-invasiveness makes it a valuable initial screening tool in emergency settings, with the potential to reshape cardiac assessment approaches and optimize patient care pathways in the ED. |
| format | Article |
| id | doaj-art-eacb42716fe34e7ebd9bfc720a270d68 |
| institution | OA Journals |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | eScholarship Publishing, University of California |
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| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-eacb42716fe34e7ebd9bfc720a270d682025-08-20T02:10:28ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182025-02-0126219119910.5811/westjem.1939419394Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in IndiaSudhi Manu0Gopinathan Vivek1Asanaru Kunju Sanjan2A. Ajay3S. Nisarg4Mymbilly Balakrishnan Jayaraj5T. R. Aishwarya6Mohammad Khalid7S. Chetana8Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576 104Department of Emergency Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, IndiaDepartment of Emergency Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, IndiaDepartment of Trauma and Emergency, All India Institute of Medical Sciences, Nagpur, IndiaDepartment of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576 104Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576 104Department of Hospital Administration, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576 104Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576 104Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576 104Introduction: Assessing cardiac function is crucial for managing acute dyspnea. In this study we aimed to evaluate displacement of the aortic root (DAR) as a method for calculating ejection fraction (EF) in patients with undifferentiated dyspnea presenting to the emergency department (ED). The primary objective was to compare EF values obtained through DAR with the modified Simpson method, which is considered the criterion reference, within an Indian academic ED. Methods: We conducted a prospective, cross-sectional study spanning two years (December 2019–December 2021). The study enrolled 110 consecutive ED patients ≥18 years of age, presenting with undifferentiated dyspnea and normal sinus rhythm. Ultrasound-trained investigators measured DAR using M-mode ultrasonography. Experienced echocardiographers, blinded to DAR, determined EF using the modified Simpson method. Statistical analyses included the Shapiro-Wilk test, McNemar test, and the receiver operating characteristic curve. Results: The mean DAR measurement was 0.781 centimeters, with an average calculated EF of 54.4%. The EF calculated using DAR did not differ significantly from EF calculated using the modified Simpson method. Comparative analysis revealed DAR’s superior sensitivity (86.21%) compared to mitral annular plane systolic excursion (48.28%) and end-point septal separation (45.45%). The DAR method exhibited high accuracy (area under the curve = 0.958) with a cut-off value 0.706 (sensitivity 88.7%, specificity 93.1%). Conclusion: Evaluating displacement of the aortic root to calculate ejection fraction in undifferentiated dyspnea demonstrated high accuracy, sensitivity, and agreement with the modified Simpson method, which is considered the criterion reference. Its simplicity and non-invasiveness makes it a valuable initial screening tool in emergency settings, with the potential to reshape cardiac assessment approaches and optimize patient care pathways in the ED.https://escholarship.org/uc/item/8td4w610 |
| spellingShingle | Sudhi Manu Gopinathan Vivek Asanaru Kunju Sanjan A. Ajay S. Nisarg Mymbilly Balakrishnan Jayaraj T. R. Aishwarya Mohammad Khalid S. Chetana Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in India Western Journal of Emergency Medicine |
| title | Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in India |
| title_full | Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in India |
| title_fullStr | Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in India |
| title_full_unstemmed | Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in India |
| title_short | Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in India |
| title_sort | unlocking cardiac insights displacement of aortic root for calculation of ejection fraction in emergency department in india |
| url | https://escholarship.org/uc/item/8td4w610 |
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