Emergency physician bedside echocardiographic identification of left ventricular diastolic dysfunction

The study protocol was approved by the Institutional Review Board of Maimonides Medical Center.2.2 Selection of participants Eligible study subjects were adult patients with a chief complaint of chest pain, shortness of breath, or syncope who had a CE ordered and performed that day. Exclusion criteria included patients who were pregnant, had atrial fibrillation at the time of FOCUS, known mitral valve repair or replacement (MVR), severe mitral annular calcification (MAC), heart rate over 100 beats per minute, time lapse between FOCUS and CE of over 8 h, and the presence of ventricular assist devices. EPs obtained an apical four chamber view and recorded the following measurements on a standardized data collection sheet: mitral inflow velocities E and A, septal TDI velocities e’ and a’, lateral TDI velocities e’ and a’, largest horizontal diameter of left atrium (LA), septal E/e’, lateral E/e’, EP assessment as to the presence or absence of DD, and EP grading of DD into mild, moderate, or severe categories. The secondary outcome was the agreement between FOCUS and CE in determining the grading of DD using the weighted kappa statistic.2.5 Sample size calculation Based on the calculated kappa of 0.64 in a prior study by Unlüer et al., a minimum of 165 patients would be needed in order to achieve 80% power to detect a difference between kappa = 0.5 and kappa = 0.64, with alpha = 0.05 [8].2.6 Data collection procedure All data were saved in password protected storage that could only be accessed by study investigators and research personnel.2.7 Statistical methods The study data was entered into and analyzed using Microsoft Excel (Microsoft Excel 2010; Microsoft Corporation, Seattle, WA) and SPSS statistical