Comparison of Emergency Echocardiographic Results be-tween Cardiologists and an Emergency Medicine Residentin Acute Coronary Syndrome

Early detection of regional wall motion abnormality (RWMA) can be a reliable tool for rapid dis-position of patients with acute coronary syndrome (ACS) in the emergency department. In this study, the di-agnostic accuracy of point-of-care echocardiography performed by a trained emergency medicine resident wasevaluated in comparison with board-certified cardiologists.

A prospective, cross-sectional study wasimplemented on adult patients with ACS. A trained emergency medicine (EM) PGY-3 resident performed point-of-care echocardiography under the supervision of two cardiologists and the reports were compared with car-diologists as a reference test.

100 patients with the mean age of 54.1 ± 11.5 years were recruited (65%male). Based on Thrombolysis in Myocardial Infarction (TIMI) and History, EKG, Age, Risk factors, and troponin(HEART) scores, 43.0% and 25.0% of patients were categorized as low-risk for ACS, respectively. The absolutemeasure of agreement between cardiologists to determine ejection fraction (EF) was 0.829 (95% CI: 0.74-0.89)based on intraclass correlation coefficient (ICC) estimation. The measurements of agreement between special-ists and the EM resident based on the analysis of Kappa coefficient were 0.677 and 0.884 for RWMA and peri-cardial effusion, respectively. Moreover, 25 patients were in the-low risk group according to the HEART scorewith an agreement rate of 92% for the lack of RWMA between the EM resident and cardiologists.

This study found acceptable agreement between the EM resident and cardiologists in assessing RWMA in differ-ent ACS risk groups. In addition, there was acceptable agreement between the EM resident and cardiologists indetermining left ventricular ejection fraction (LVEF) and pericardial effusion.