Right Ventricular “Bubble Time” to Identify Patients With Right Ventricular Dysfunction - 18/07/24
, Timmy Li, PhD a, b, Nicholas Bielawa, PA-C b, Alexander Nello, DO b, Allen Gold, DO c, Margaret Gorlin, MS d, Mathew Nelson, DO a, b, Edward Carlin, MD a, b, Daniel Rolston, MD, MSHPM a, bAbstract |
Study objective |
We propose a novel method of evaluating right ventricular (RV) dysfunction in the emergency department (ED) using RV “bubble time”—the duration of time bubbles from a saline solution flush are visualized in the RV on echocardiography. The objective was to identify the optimal cutoff value for RV bubble time that differentiates patients with RV dysfunction and report on its diagnostic test characteristics.
Methods |
This prospective diagnostic accuracy study enrolled a convenience sample of hemodynamically stable patients in the ED. A sonographer administered a 10-mL saline solution flush into the patient’s intravenous catheter, performed a bedside echocardiogram, and measured RV bubble time. Subsequently, the patient underwent a comprehensive cardiologist-interpreted echocardiogram within 36 hours, which served as the gold standard. Patients with RV strain or enlargement of the latter found on an echocardiogram were considered to have RV dysfunction. Bubble time was evaluated by a second provider, blinded to the initial results, who reviewed the ultrasound clips. The primary outcome measure was the optimal cutoff value of RV bubble time that identifies patients with and without RV dysfunction.
Results |
Of 196 patients, median age was 67 year, and half were women, with 69 (35.2%) having RV dysfunction. Median RV bubble time among patients with RV dysfunction was 62 seconds (interquartile range [IQR]: 52, 93) compared with 21 seconds (IQR: 12, 32) among patients without (P<.0001). The optimal cutoff value of RV bubble time for identifying patients with RV dysfunction was 40 or more seconds, with a sensitivity of 0.97 (95% CI 0.93 to 1.00) and specificity of 0.87 (95% CI 0.82 to 0.93).
Conclusion |
In patients in the ED, an RV bubble time of 40 or more seconds had high sensitivity in identifying patients with RV dysfunction, whereas an RV bubble time of less than 40 seconds had good specificity in identifying patients without RV dysfunction. These findings warrant further investigation in undifferentiated patient populations and by emergency physicians without advanced ultrasound training.
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| Supervising editor: Frank Scheuermeyer, MD, MHSc. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: AC conceived the study, designed the study, supervised the conduct of the study and data collection, recruited patients, and managed the data, including quality control. TL assisted with designing the study and managed the data. NB, AN, and AG recruited patients, collected data, and managed the data. TL and MG provided statistical advice on the study design and analyzed the data. AC, TL, MN, and DR drafted the manuscript, and all authors contributed substantially to its revision. EC was involved in enrolling patients, editing the manuscript and assisted in developing the protocol. AC takes responsibility for the manuscript as a whole. |
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| Data sharing statement: The limited dataset is available upon request from the date of article publication by contacting Dr. Allison Cohen at acohen20@northwell.edu and after executing a data sharing agreement between parties involved. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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| Prior presentations: Preliminary results of the study were presented at the American College of Emergency Physicians Research Forum in October 2021 in Boston, MA. |
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| Please see page 183 for the Editor’s Capsule Summary of this article. |
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Vol 84 - N° 2
P. 182-194 - août 2024 Retour au numéro
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