Accuracy and reliability of focused echocardiography in patients with Chagas disease from endemic areas: SaMi-Trop cohort study

Background Chagas disease remains a major cause of cardiovascular death in endemic areas. Focused echocardiography (FoCUS) is a point-of-care means of assessing cardiac function which can be useful for the diagnosis of cardiac involvement. Objective This study aims evaluating the characteristics of validity and reliability of FoCUS applied on Chagas disease patients. Methods Patients with Chagas disease coming from an endemic area were selected from a large cohort (SaMi-Trop). A simplified echocardiogram with only three images was extracted from the conventional echocardiogram performed in this cohort. The images were evaluated by an observer who was blinded to the clinical and echocardiographic data, to determine the accuracy and reliability of FoCUS for cardiac assessment. The analysis constituted of 5 prespecified variables, dichotomized in absence or presence: left ventricular (LV) size and systolic function, right ventricular (RV) size and systolic function, and LV aneurysm. Results We included 725 patients with a mean age of 63.4 ± 12.3 years, 483 (67%) female. Abnormal electrocardiogram was observed in 81.5% of the patients. Left and right ventricular dysfunctions were found in 103 (14%) and 49 (7%) of the patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 84%, 94%, 70% and 97% for LV enlargement and 81%, 93%, 68% and 97% for LV systolic dysfunction, respectively, and 46%, 99%, 60% and 98% for RV dilatation, and 37%, 100%, 100% and 96% for RV dysfunction, respectively. Inter and intraobserver agreement were 61% and 87% for LV enlargement and 63% and 92% for LV dysfunction, respectively, and 50% and 49% for RV size and 46% and 79% for RV dysfunction, respectively. LV apical aneurysm was found in 45 patients (6.2%) with the lowest sensitivity of FoCUS study (11%; 95% CI 2–28%). Conclusions FoCUS showed satisfactory values of validity and reliability for assessment of cardiac chambers in patients with Chagas disease, except for apical aneurysm. This tool can identify heart disease with potential impact on patient management in the limited-resource setting.

P.071 Focused cardiac ultrasound in stroke: a feasibility study

Background: Canadian Stroke Best Practice Recommendations recommend both cardiac monitoring and transthoracic echocardiography (TTE) to assess for cardioembolic sources of stroke. TTE has a diagnostic yield which is historically low at 5-10%. The goal of this project was to evaluate the practicality of a bedside, focused approach to TTE in ischemic stroke. Methods: This is a cross-sectional study evaluating patients undergoing echocardiography for evidence of possible cardioembolic stroke. It compared the standard and focused TTE imaging approaches. Of the 61 patients reported, data is currently available for 15 participants. Independent samples t-test were performed to compare measurements. Results: Mean time to finish image acquisition for the focused TTE was significantly shorter than the complete TTE (12 min or less vs 30 min or more) (p<0.0001). No cardiac sources of stroke were found by either mechanism in this cohort, representing 100% agreement between the two modalities. Conclusions: Focused echocardiography studies are quicker to execute and employ more affordable, portable, digital TTE devices. The test is done at bedside, reducing the need for patient transport. Image acquisition takes approximately half the time to obtain. This potentially allows for more rapid clinical decision making and can facilitate discharge from the hospital.

Signs of congestion in patients with perioperative atrial fibrillation in major noncardiac surgery

Funding Acknowledgements Type of funding sources: None. Purpose to evaluate the frequency of perioperative atrial fibrillation in patients with postoperative signs of systemic congestion. Methods we examined 102 patients who underwent cardiac monitoring in the perioperative period to detect episodes of atrial fibrillation and focused echocardiography to detect signs of systemic congestion. All patients underwent abdominal surgery lasting more than 180 minutes.Clinical, laboratory, and echocardiographic criteria were used to verify systemic stagnation in the postoperative period in patients after non-cardiac surgery. Results we determined the number of patients with perioperative AF who had acute decompensation of HF in the early postoperative period, determined by signs of systemic stagnation. When assessing the number of patients with preoperative anamnestic AF, which was initially 16 people, in 100% of cases in the postoperative period, decompensation of HF was noted. When evaluating the number of patients with intraoperative AF, which was detected in 24 patients, decompensation of HF in the first 24 hours after abdominal surgery was observed in 23 patients (95.8%) (OR: 25.4; 95% CI: 3.27-198.14; p &lt;0.001). When assessing the number of patients with postoperative AF, which was detected in 36 patients, decompensation of HF in the first 24 hours after abdominal surgery was observed in 35 patients (97.2%) (OR:57.4;95% CI:7.39-435.45; p &lt;0.001). Conclusion in major non-cardiac operations, most patients with perioperative atrial fibrillation show signs of systemic stagnation in the postoperative period with FOCUS.

Role of ultrasound in cardiopulmonary resuscitation: Ultrasound CPR

Ultrasound has predictive value of identification and management of reversible causes of cardiac arrest on the outcome after applied CPR, in terms of ROSC (return of spontaneous circulation) and the hospital discharge and neurological findings after applied CPR measures. Ultrasound is used in all phases of resuscitation including period before cardiac arrest, during cardiopulmonary resuscitation (CPR), and in the period after that. Ultrasound use during CPR offers numerous advantages including non-invasiveness, easiness, the short time for examination and a safe possibility for a repeat test whenever it is needed. Focused Echocardiography Examination in Life support (FEEL) and Focused Echocardiographic Evaluation in Resuscitation (FEER) protocols are mostly used when we talk about heart examination in cardiopulmonary resuscitation.

Just the Facts: The Five F's of Focused Echocardiography in Shock

A 60-year-old female presents to the emergency department (ED) with a 3-day history of fatigue and mild breathlessness. She has a history of lung cancer. Her vitals indicate shock with a heart rate of 140 bpm, a systolic blood pressure (SBP) of 65 mmHg, a respiratory rate of 28, with an oxygen saturation of 90% on 100% a nonrebreather mask, and a normal temperature at 36°C. Her electrocardiograph (ECG) shows sinus tachycardia. She appears mottled and pale.

Focused echocardiography in COVID-19: An unusual case of acute right ventricular dysfunction

Background During the novel coronavirus disease 2019 (COVID-19) pandemic, rapid diagnostics have been frequently sought to quickly evaluate a patient’s condition. Lung ultrasound can provide an early glimpse into the disease process and its severity. The addition of focused echocardiography can be particularly helpful in the haemodynamically compromised patient to detect myocardial involvement and alternative diagnoses. Case We discuss here a 53-year-old patient who presented to the Emergency Department with hypoxia and hypotension. Bedside focused ultrasound revealed signs of COVID-19 pneumonia with evidence of right ventricular strain, initially thought to be due to massive pulmonary embolism. A computed tomography scan confirmed the findings on ultrasonography, but surprisingly did not demonstrate a pulmonary embolism. Conclusion Point-of-care ultrasound in COVID-19 aided the diagnosis of affected organs and helped categorise the type of shock in this patient; however, right ventricular dysfunction should be interpreted with caution and may not be due to a pulmonary embolism, as in this case.