Abstract:P atients presenting to the emergency department (ED) with chest pain represent a significant healthcare burden; the estimated annual cost to the US economy is $10 to $12 billion.1 A large proportion of ED admissions are patients with suspected acute coronary syndrome (ACS) but with a nondiagnostic ECG and a normal 12-hour troponin, although fewer than half are subsequently diagnosed with ACS.2 A retrospective study found that the mean cost per patient was ≈$3200, with 73% of cost attributable to admission tim… Show more
“…These findings are in contrast to SE studies performed in younger populations 4 5. CKD is highly prevalent in elderly populations (23% of our population) and forebodes worse outcomes, with predialysis patients having nine times higher death rates in comparison to population controls 12 13.…”
In octogenarians, SE demonstrated excellent feasibility, safety and diagnostic accuracy. SE parameters were independent predictors of NFMI and CV events, and the presence of inducible ischaemia was associated with a 50% increase in all-cause mortality.
“…These findings are in contrast to SE studies performed in younger populations 4 5. CKD is highly prevalent in elderly populations (23% of our population) and forebodes worse outcomes, with predialysis patients having nine times higher death rates in comparison to population controls 12 13.…”
In octogenarians, SE demonstrated excellent feasibility, safety and diagnostic accuracy. SE parameters were independent predictors of NFMI and CV events, and the presence of inducible ischaemia was associated with a 50% increase in all-cause mortality.
“…Obrazowanie obciążeniowe jest preferowane w stosunku do elektrokardiograficznej próby wysiłkowej ze względu na większą dokładność diagnostyczną [63]. W różnych badaniach wykazano, że prawidłowy wynik echokardiografii obciążeniowej (wysiłkowej, dobutaminowej lub z dipirydamolonem) ma wysoką, ujemną wartość predykcyjną dla niedokrwienia i wiąże się z doskonałymi wynikami klinicznymi u pacjentów [64,65]. Co więcej, echokardiografia obciążeniowa wykazuje większą wartość prognostyczną niż próba wysiłkowa EKG [64,66].…”
Section: Ocena Czynnościowaunclassified
“…W różnych badaniach wykazano, że prawidłowy wynik echokardiografii obciążeniowej (wysiłkowej, dobutaminowej lub z dipirydamolonem) ma wysoką, ujemną wartość predykcyjną dla niedokrwienia i wiąże się z doskonałymi wynikami klinicznymi u pacjentów [64,65]. Co więcej, echokardiografia obciążeniowa wykazuje większą wartość prognostyczną niż próba wysiłkowa EKG [64,66]. Zastosowanie kontrastu może poprawić wizualizację granic wsierdzia, co potencjalnie zwięk-sza szansę wykrycia niedokrwienia [67].…”
“…A recent observational study involving almost 900 patients presenting with acute chest pain demonstrated that diagnostic image quality was feasible in almost 99% (contrast ultrasound agent was used in 52% of these patients with unselected BMI) with optimal prognostic outcome 5. Guidelines endorse the use of contrast during SE for improved reader confidence and study accuracy 6 7…”
Section: Discussionmentioning
confidence: 99%
“…In a clinical setting, we recently reported a feasibility for diagnostic images of >99% in consecutive patients presenting with acute chest pain using state-of-the-art SE techniques as described above 5. We hypothesised that contrast-enhanced SE will be a useful technique for implementing an optimal management strategy in obese patients presenting with suspected angina.…”
Contemporary SE has excellent feasibility and positive predictive value and resulted in appropriate risk stratification of symptomatic patients with significant obesity. A normal SE portends an excellent outcome over the short-intermediate term in this high-risk patient population.
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