Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: a multicenter study

Kaul, Sanjiv; Senior, Roxy; Firschke, Christian; Wang, Xin Qun; Lindner, Jonathan R.; Villanueva, Flordeliza S.; Firozan, Soroosh; Kontos, Michael C.; Taylor, Allen J.; Nixon, Ian J.; Watson, Denny D.; Harrell, Frank E.

doi:10.1016/j.ahj.2003.12.041

Cited by 105 publications

(48 citation statements)

References 24 publications

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“…Several reports have demonstrated that functional parameters have an incremental value over perfusion alone for the diagnosis of coronary artery disease and the evaluation of its extent and severity [76][77][78][79][80][81][82]. It is well known that the possibility of visualising the motion and thickening of apparently hypoperfused segments significantly improves the diagnostic accuracy of perfusion SPECT, particularly in terms of increased specificity [2].…”

Section: Incremental Diagnostic Value Of Function Over Perfusionmentioning

confidence: 99%

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Sciagrà

2007

Eur J Nucl Med Mol Imaging

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Background Gating of single-photon emission computed tomography (SPECT) has significantly improved the reliability and diagnostic accuracy of myocardial perfusion imaging. The functional parameters derived from this technique, mainly left ventricular volumes and ejection fraction, have been demonstrated to be accurate and reproducible. They are able to increase the detection of severe and extensive coronary artery disease and show a significant incremental prognostic power over perfusion abnormalities. Therefore, the importance given to gated SPECT functional data has progressively grown. Discussion This circumstance has further expanded the indications for myocardial perfusion imaging and strengthened its position among the different imaging modalities. Moreover, several studies show that the evaluation of ventricular function may have a leading part in justifying the execution of perfusion scintigraphy in various clinical conditions. Aim Aim of this review is to describe this evolution of gated SPECT functional assessment from a supporting rank with respect to perfusion, to a main actor position in the field of cardiac imaging.

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Section: Incremental Diagnostic Value Of Function Over Perfusionmentioning

confidence: 99%

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Sciagrà

2007

Eur J Nucl Med Mol Imaging

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“…Standard initial diagnostic evaluation lacks sufficient sensitivity for UA (2); therefore, many lowrisk patients are admitted, resulting in significant cost to the health care system. Resting myocardial perfusion imaging (MPI) using 99m Tc with gated SPECT has been shown to provide information for risk-stratification of this population beyond the standard evaluation (3)(4)(5)(6). In this setting, radionuclide MPI has demonstrated favorable test characteristics, including a high negative predictive value for cardiac events (3,7,8).…”

mentioning

confidence: 99%

Resting Radionuclide Myocardial Perfusion Imaging in a Chest Pain Center Including an Overnight Delayed Image Acquisition Protocol

Td²,

Ja³

et al. 2007

Journal of Nuclear Medicine Technology

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Emergency department (ED) patients with chest pain (CP) and a nondiagnostic electrocardiogram (ECG) present difficult management decisions. The purpose of this study was to investigate the utility of resting radionuclide SPECT myocardial perfusion imaging (SPECT MPI)-including an overnight delayed image acquisition protocol-in identifying patients presenting to the ED with CP at risk for cardiac events. Methods: Patients presenting to the ED with CP and a nondiagnostic ECG were prospectively enrolled and underwent chest pain center evaluation. All patients also underwent resting gated SPECT MPI using 99m Tc-tetrofosmin tracer. Patients presenting on weeknights between 12 AM and 6 AM had tracer injection in the ED with image acquisition delayed until later in the morning. Patients were monitored for a 30-d occurrence of cardiac events. Results: Over a 16-mo period, 479 patients were enrolled and completed follow-up. For the prediction of 30-d cardiac events, resting SPECT MPI demonstrated a sensitivity and a specificity of 76.9% and 92.4%, respectively. Positive and negative predictive values were 22.2% and 99.3%, respectively. Among the 3 patients with a normal perfusion scan who suffered cardiac events, all had tracer injection several hours after resolution of CP. The overnight delayed image acquisition protocol provided a negative predictive value of 100% for the 44 patients whose image acquisition was delayed until the following morning. Conclusion: A normal resting SPECT MPI in ED patients presenting with CP predicts a very low occurrence of 30-d cardiac events. A delayed image acquisition protocol did not decrease the accuracy of SPECT MPI. Such a protocol may be useful in increasing the availability of this imaging modality. Pat ients often present to the emergency department (ED) with a complaint of chest pain (CP) and a nondiagnostic 12-lead electrocardiogram (ECG). Management decisions with these patients are difficult. Patients with noncardiac CP or low-risk angina can be safely discharged from the ED with appropriate follow-up (1). Rarely, patients with true unstable angina (UA) or myocardial infarction (MI) are discharged from the ED with potentially dire consequences (2). Standard initial diagnostic evaluation lacks sufficient sensitivity for UA (2); therefore, many lowrisk patients are admitted, resulting in significant cost to the health care system. Resting myocardial perfusion imaging (MPI) using 99m Tc with gated SPECT has been shown to provide information for risk-stratification of this population beyond the standard evaluation (3-6). In this setting, radionuclide MPI has demonstrated favorable test characteristics, including a high negative predictive value for cardiac events (3,7,8). Furthermore, MPI in the ED has been shown to be useful for clinical decision making (7-10) and to provide further information beyond that provided by serum biomarkers, including troponin (11). Rest MPI results also have short and intermediate prognostic implications in this setting (12,13). The ability to offer...

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“…Kaul et al [33] reported that MCE has incremental value for both diagnosis and short-term prognosis in patients presenting to the emergency department with chest pain and without ST-segment elevation.…”

Section: Acute Chest Pain Without St-segment Elevationmentioning

confidence: 99%

Assessment of Myocardial Perfusion With Intravenous Myocardial Contrast Echocardiography Current State and Clinical Applications

Chung

2006

J Echocardiogr

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Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: a multicenter study

Cited by 105 publications

References 24 publications

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Resting Radionuclide Myocardial Perfusion Imaging in a Chest Pain Center Including an Overnight Delayed Image Acquisition Protocol

Assessment of Myocardial Perfusion With Intravenous Myocardial Contrast Echocardiography Current State and Clinical Applications

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