# Accuracy of Emergency Physician-Performed Echocardiography for Diastolic Dysfunction in Suspected Acute Heart Failure: A Systematic Review and Meta-Analysis

## TL;DR

Emergency physicians can accurately rule out heart failure using ultrasound, but it's less reliable for confirming the condition.

## Contribution

This study provides a meta-analysis on the diagnostic accuracy of emergency physician-performed echocardiography for diastolic dysfunction.

## Key findings

- EP-performed FCU showed excellent sensitivity (94%) for ruling out diastolic dysfunction.
- Specificity was moderate (59%), limiting its use for confirming the diagnosis.
- Three of four studies had a high risk of bias, suggesting potential limitations in the findings.

## Abstract

Background: This study compared the accuracy of diagnosing left ventricular diastolic dysfunction (DD) between emergency physician (EP)-performed focused cardiac ultrasound (FCU) and cardiologist-interpreted reference standards in adult patients presenting to the emergency department (ED) with suspected acute heart failure (HF). Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched for studies focusing on adult ED patients with symptoms of acute HF that compared the accuracy of DD diagnosis between EP-performed FCU and reference standards including cardiologist-reviewed FCU clips, formal transthoracic echocardiography, or invasive hemodynamics without language/date restrictions. Results: Meta-analysis of four eligible observational studies (327 patients enrolled; 298 analyzed) demonstrate excellent sensitivity of EP-performed FCU compared with the standards (94%, 95% CI: 87 to 97%) but moderate specificity (59%, 95% CI: 42 to 74%) in diagnosing DD patients with suspected acute HF. Three of the four studies showed a high risk of overall bias. Conclusions: EP-performed FCU exhibited excellent sensitivity and low negative likelihood ratios, supporting its use as an effective initial triage tool for ruling out DD in ED patients with suspected acute HF. However, its moderate specificity and limited positive likelihood ratios hamper its standalone use as a definitive diagnostic modality for ruling in DD (PROSPERO: CRD420251046794).