Document Type
Article
Journal Title
Journal of Hospital Medicine
Publication Date
2025
Abstract
BACKGROUND: Left atrial enlargement (LAE) is predictive of cardiovascular morbidity and mortality. Prior studies of point-of-care ultrasound (POCUS) interpretation methods for identifying LAE utilized older echocardiographic reference ranges.
OBJECTIVES: Compare the test characteristics of hospitalist-performed POCUS techniques for identifying LAE as compared to contemporary echocardiographic reference ranges.
METHODS: Fully paired, comparative diagnostic accuracy study of two index tests applied to archived echocardiogram images: visual assessment of the left atrium to aorta diameter (LAE sign) and left atrial (LA) anteroposterior diameter >4 cm in the parasternal long axis view. The reference test was moderate to severe LAE by echocardiography-derived left atrial volumetric index.
RESULTS: After exclusion criteria, 239 of 321 (74.5%) exams were included. The LAE sign had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 67.5%, 71.4%, 32.1%, and 91.6%. LA diameter of >4 cm had a sensitivity, specificity, PPV, and NPV of 87.5%, 75.9%, 42.2%, and 96.8%. The difference in sensitivity (p = .005) and specificity (p = .049) between the index tests was statistically significant. The diameter measurement had better positive and negative likelihood ratios (LR + 3.63, LR-0.16) than the LAE sign (LR + 2.36, LR- 0.46).
CONCLUSIONS: Both POCUS techniques for diagnosing LAE performed reasonably well compared to current echocardiographic reference ranges, with LA diameter >4 cm having better sensitivity and specificity than visual estimation of the LAE sign. These tests can help identify patients at risk for cardiovascular disease who may benefit from echocardiogram referral.
DOI Link
ISSN
1553-5606
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Smith, Christopher J.; Umbra, Jesse; Quintero, Sofia; Wilson, Austin; Lyden, Elizabeth; Tiwari, Nidish; Shahan, Brian; and Wardian, Jana L., "Comparative Diagnostic Accuracy Study of Point of Care Ultrasound Techniques for Detection of Left Atrial Enlargement by Hospital Medicine Physicians from Archived Echocardiogram Images" (2025). Journal Articles: Hospital Medicine. 45.
https://digitalcommons.unmc.edu/com_hosp_articles/45