ArticleJournal of hospital medicine2026
Comparative diagnostic accuracy study of point of care ultrasound techniques for detection of left atrial enlargement by hospital medicine physicians from archived echocardiogram images.
Article in Journal of hospital medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLeft 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.
objectivesCompare the test characteristics of hospitalist-performed POCUS techniques for identifying LAE as compared to contemporary echocardiographic reference ranges.
methodsFully 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.
resultsAfter 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).
conclusionsBoth 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.
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