• Imen Trabelsi, Mohamed A Msolli, Adel Sekma, Nizar Fredj, Zohra Dridi, Nasri Bzeouich, Mohamed F Najjar, Imen Gannoun, Malek Mzali, Kamel Laouiti, Kaouthar Beltaief, Mohamed H Grissa, Asma Belguith, Riadh Boukef, Wahid Bouida, Hamdi Boubaker, Semir Nouira, and GREAT Network.
• Research Laboratory LR12SP18, University of Monastir, Tunisia.
• Int. J. Clin. Pract. 2020 Oct 1; 74 (10): e13572.

Aim Of The StudyThe diagnosis of heart failure in the emergency department (ED) is challenging. The aim of this study was to evaluate systolic time intervals (STIs) using phonoelectrocardiography for the diagnosis of heart failure (HF) in ED patients with undifferentiated dyspnea.MethodsA total of 855 patients with dyspnea and suspected HF were prospectively enrolled. They underwent echocardiographic measurements of left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP) testing and computerised phonoelectrocardiography to assess STIs including electromechanical activation time (EMAT), left ventricular ejection time (LVET) and EMAT/LVET ratio. Diagnosis accuracy of STIs was calculated including sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve.ResultsPatients with HF (n = 530) had significantly higher EMAT and lower LVET compared with non-HF patients. ROC curve c-statistic was 0.74, 0.72 and 0.78 for EMAT, LVET and EMAT/LVET respectively. Sensitivity and specificity of EMAT/LVET at a cut-off = 40% were 72% and 88% respectively. EMAT/LVET had the highest correlation with LVEF (r = 0.48). In patients with intermediate BNP (n = 107), positive likelihood ratio increased from 1.8 with BNP alone to 3.6 with BNP combined to EMAT/LVET. Patients without HF had STIs values not significantly different from those with preserved LVEF (≥45%).ConclusionsGiven their immediate availability, phonoelectrocardiography STIs' parameters and particularly EMAT/LVET ratio could have an important role in the diagnosis approach of HF in patients with undifferentiated dyspnea in the ED.© 2020 John Wiley & Sons Ltd.

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