CAN EMERGENCY MEDICINE RESIDENTS DIAGNOSE NEUROGENIC STUNNED MYOCARDIUM IN THE EMERGENCY DEPARTMENT BY FOCUSED ASSESSMENT DIAGNOSTIC ECHOCARDIOGRAPHY

Background and Aim : To assess the ability of trained emergency medicine (EM) residents todiagnose Neurogenic stunned myocardium (NSM) in patients with acute intracranial events in theemergency department (ED) using the Focused Assessment diagnostic Echocardiography (FADE).Methods : This prospective cross-sectional study was conducted between February 2018 andJanuary 2019. First, four PGY-3 EM residents were trained through participation in 10 hours oftheoretical FADE education and 20 hands-on FADE on ED patients. Then, adult patients (agedover 18 years old) with acute cerebrovascular accidents (CVAs) were enrolled in the study.Patients with a history of prior cardiac disease, concurrent CVA and ST-elevation myocardia linfarction (STEMI), and cardiopulmonary arrest in the ED were excluded. The results ofechocardiography by the cardiologists were considered as the gold standard.Results : Eighty-five cases were enrolled in the final analysis. The mean age of participants was62.7 years, and 47 (55.3%) were male. There was a good agreement between the EM residents andcardiologists in diagnosing LV dysfunction (Cohen’s Kappa = 0.7, 95%CI=0.65-0.8). Troponin Iwas positive in 3 (3.5%) patients. Based on the diagnosis of Cardiologists, All three patients hadheart failure and received a definitive diagnosis of NSM. Whereas, according to the FADE examby EM residents, 2 out of 3 cases with positive enzyme had heart failure (Interrater agreement =66.6%).Conclusion : Our study showed that trained EM residents could use the FADE exam to diagnosethe NSM in CVA patients in the ED.