E-Point Septal Separation Accuracy for the Diagnosis of Mild and Severe Reduced Ejection Fraction in Emergency Department Patients

Introduction: In the Emergency Department (ED), a thorough cardiovascular evaluation cannot be accomplished only with physical examination. E-Point Septal Separation (EPSS) measure through Point-of-Care Ultrasound (POCUS) has been used to evaluate systolic function in echocardiography. We analyzed EPSS for diagnosis of Left Ventricle Ejection Fraction <50% and ≤40% in ED patients. Methods: Retrospective analysis of a convenience sample of patients presenting to ED with chest pain or dyspnea who underwent admission POCUS evaluation by Internal Medicine Specialist unaware of Transthoracic Echocardiogram. Accuracy was assessed with sensitivity, specificity, likelihood ratios (LR) and Receiver operating characteristics (ROC) curve. The best cut off point was calculated using Youden Index. Results: Ninety-six patients were included. Median EPSS and LVEF were 10mm and 41% respectively. Area Under the ROC Curve (AUC-ROC) to diagnose a LVEF <50% was 0.90 (IC95% 0.84-0.97). Youden Index was 0.71 with cut off point EPSS at 9.5mm, performing with a sensitivity of 0.80, a specificity of 0.91, a positive LR of 9.8 and a negative LR of 0.2. AUC-ROC to diagnose a LVEF ≤40% was 0.91 (IC95% 0.85-0.97). Youden Index was 0.71 with a cut off point EPSS at 9.5mm, performing with a sensitivity of 0.91 and specificity of 0.80, a positive LR of 4.7 and a negative LR of 0.1. Conclusion: EPSS can reliably diagnose reduced LVEF in a set of ED patients with cardiovascular symptoms. A cut off point at 9.5 mm has good sensitivity, specificity and Likelihood ratios.

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