FOCUS may detect wall motion abnormalities in patients with ACS

Bracey, Alexander; Massey, Lyndsay; Pellet, Andrew; Thode, Henry C.; Holman, Thomas R.; Singer, Adam J.; McClure, Matthew; Secko, Michael

doi:10.1016/j.ajem.2023.03.056

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…An additional 10 eligible studies were identified through search engines and handsearching of reference lists of included studies, with a total of 29 studies included in the review (Fig. 1) [24][25][26][27][28][29][30].…”

Section: Resultsmentioning

confidence: 99%

“…See e-Table 1 (Additional File 1: e-Appendix 4) for additional information. [20], hand-held or cart/tray based devices in four studies [28,57,74,76] and not reported in five studies [26,56,59,65,77]. The characteristics of the index test for the included studies are summarized in Table 2.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The reference standard varied widely across studies, using final diagnosis or chart review [26,29,30,57,59,64,71,72,76,77], cardiac enzymes results [61,70,73], a combination of tests (between ECG, cardiac enzymes, non-invasive testing, and coronary angiography) [24,25,27,62,63,[65][66][67]74] or significant coronary artery stenosis [28,58,60,68,69,75]. The definition of significant coronary stenosis varied between ≥ 50% [58,69] to ≥ 70% narrowing in epicardial coronary arteries [23,66].…”

Section: Cardiac Ultrasound Was Conducted As Pocus Inmentioning

confidence: 99%

“…Overall, most studies were at high risk of bias due to patient selection and reference standard factors. High risk of bias was found in the patient selection domain (22 [23,28,30,57,58,63,66,72,75,76] and two studies with high concerns for applicability. [29,74] (Fig.…”

Section: Quality Assessment Of Included Studiesmentioning

confidence: 99%

“…Several studies have assessed cardiac ultrasound diagnostic accuracy for acute myocardial ischemia in patients with acute chest pain with a wide range of sensitivities (21% to 100%) [26,27] and specificities (33% to 100%) reported [28,29]. This uncertainty may be due to the fact that many of these studies are small, and the patient spectrum, ultrasound timing, protocols, devices and providers vary [24,25,[30][31][32].…”

Section: Introductionmentioning

confidence: 99%

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The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis

Zarama,

Arango-Granados,

Manzano-Nunez

et al. 2024

Scand J Trauma Resusc Emerg Med

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Background Chest pain is responsible for millions of visits to the emergency department (ED) annually. Cardiac ultrasound can detect ischemic changes, but varying accuracy estimates have been reported in previous studies. We synthetized the available evidence to yield more precise estimates of the accuracy of cardiac ultrasound for acute myocardial ischemia in patients with chest pain in the ED and to assess the effect of different clinical characteristics on test accuracy. Methods A systematic search for studies assessing the diagnostic accuracy of cardiac ultrasound for myocardial ischemia in the ED was conducted in MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Web of Science, two trial registries and supplementary methods, from inception to December 6th, 2022. Prospective cohort, cross-sectional, case–control studies and randomized controlled trials (RCTs) that included data on diagnostic accuracy were included. Risk of bias was assessed with the QUADAS-2 tool and a bivariate hierarchical model was used for meta-analysis with paired Forest and SROC plots used to present the results. Subgroup analyses was conducted on clinically relevant factors. Results Twenty-nine studies were included, with 5043 patients. The overall summary sensitivity was 79.3% (95%CI 69.0–86.8%) and specificity was 87.3% (95%CI 79.9–92.2%), with substantial heterogeneity. Subgroup analyses showed increased sensitivity in studies where ultrasound was conducted at ED admission and increased specificity in studies that excluded patients with previous heart disease, when the target condition was acute coronary syndrome, or when final chart review was used as the reference standard. There was very low certainty in the results based on serious risk of bias and indirectness in most studies. Conclusions Cardiac ultrasound may have a potential role in the diagnostic pathway of myocardial ischemia in the ED; however, a pooled accuracy must be interpreted cautiously given substantial heterogeneity and that important patient and test characteristics affect its diagnostic performance. Protocol Registration: PROSPERO (CRD42023392058).

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