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{ "pk": 50527, "title": "Accuracy of Emergency Physicians in Grading Diastolic Dysfunction Using Visual Estimation of Waveforms", "subtitle": null, "abstract": "<p><strong>Introduction:</strong> Diastolic dysfunction occurs when the ventricular walls of the heart stiffen and fail to relax appropriately. Early recognition in the emergency department (ED) enables identification of heart failure with preserved ejection fraction, guides antihypertensive and diuretic therapy, and facilitates timely cardiology referral to reduce morbidity and readmissions. Prior studies show emergency physicians (EP) can diagnose diastolic dysfunction with point-of-care ultrasound using mitral valve inflow velocities and tissue Doppler indices, although quantitative measurements are time-consuming. This study evaluates whether EPs can accurately diagnose and grade diastolic dysfunction based solely on visualization of mitral valve inflow velocities and tissue Doppler wave forms.</p>\n<p><strong>Methods:</strong> After a focused training session, EPs (postgraduate year 1-3 residents, ultrasound fellows, and attendings) were randomized to review archived echocardiograms obtained by certified technicians. The EPs visually assessed echocardiograms for diastolic dysfunction (grades I-III) and whether they were considered “severe” (grade III). Their interpretations were then compared with a cardiologist’s gold-standard readings.</p>\n<p><strong>Results:</strong> Twenty-three EPs interpreted 100 echocardiograms containing 25 of each grade. Overall accuracy for exact grading was 54.8%. Ultrasound attendings scored highest (70.0%), followed by non-ultrasound fellows (55.0%), attendings (54.0%), and residents (52.9%). For identification of any diastolic dysfunction, the EPs had a sensitivity of 84.6% (95% CI, 78.5-89.5%), specificity of 44.8% (95% CI, 31.7-58.5%), positive likelihood ratio (+LR) 1.53 (95% CI, 1.21-1.95), and negative likelihood ratio (-LR) 0.34 (95% CI, 0.22-0.54). For identification of severe diastolic dysfunction, the EPs’ intrepretations had a sensitivity of 59.4% (95% CI, 46.4-71.5%), specificity of 90.3% (95% CI, 85.0-94.3%), +LR 6.15 (95% CI 3.75-10.09), and -LR 0.45 (95% CI, 0.33-0.61).</p>\n<p><strong>Conclusion: </strong>Emergency physicians can visually estimate diastolic function using mitral valve inflow velocities and tissue Doppler morphology with good sensitivity for detecting dysfunction and high specificity for identifying severe cases. </p>", "language": "eng", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "POCUS" }, { "word": "ultrasound" }, { "word": "Echocardiography" }, { "word": "Heart Failure" }, { "word": "diastolic dysfunction" } ], "section": "Cardiology", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5h86c4mf", "frozenauthors": [ { "first_name": "Daniel", "middle_name": "L.", "last_name": "Puebla", "name_suffix": "", "institution": "Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida; Florida International University, Herbert Wertheim College of Medicine, Miami, Florida", "department": "" }, { "first_name": "Edward", "middle_name": "", "last_name": "Lopez", "name_suffix": "", "institution": "Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida; Loma Linda University, Department of Emergency Medicine, Loma Linda, California", "department": "" }, { "first_name": "Tarang", "middle_name": "", "last_name": "Kheradia", "name_suffix": "", "institution": "Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida", "department": "" }, { "first_name": "Tony", "middle_name": "", "last_name": "Zitek", "name_suffix": "", "institution": "Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida; Kaiser Permanente Modesto Medical Center, Department of Emergency Medicine, Modesto, California", "department": "" }, { "first_name": "Anthony", "middle_name": "", "last_name": "Catapano", "name_suffix": "", "institution": "Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida; Florida International University, Herbert Wertheim College of Medicine, Miami, Florida", "department": "" }, { "first_name": "Robert", "middle_name": "A.", "last_name": "Farrow II", "name_suffix": "", "institution": "Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida; Florida International University, Herbert Wertheim College of Medicine, Miami, Florida", "department": "" }, { "first_name": "David", "middle_name": "H.", "last_name": "Kinas", "name_suffix": "", "institution": "Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida; Florida International University, Herbert Wertheim College of Medicine, Miami, Florida", "department": "" } ], "date_submitted": "2025-07-31T08:27:48.790000-07:00", "date_accepted": "2025-11-14T14:39:29.439000-08:00", "date_published": "2026-02-22T01:47:00-08:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/50527/galley/49063/download/" } ] }