Stress echocardiography in the ED: diagnostic performance in high-risk subgroups

Innocenti, Francesca; Lazzeretti, Delia; Conti, Alberto; Zanobetti, Maurizio; Vicidomini, Sonia; Pini, Riccardo

doi:10.1016/j.ajem.2013.05.006

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…Initially, 952 articles were identified for screening, 81 met criteria for full‐text review, and 33 articles were included in this meta‐analysis. Of the 33 studies, seven were randomized controlled trials, 30–36 17 were prospective cohort studies, 37–53 and the remaining nine were retrospective cohort studies 54–62 …”

Section: Resultsmentioning

confidence: 99%

“…Of the 33 studies, seven were randomized controlled trials, 30-36 17 were prospective cohort studies, [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] and the remaining nine were retrospective cohort studies. [54][55][56][57][58][59][60][61][62] The type of testing utilized varied in each study, and some assessed multiple modalities. Specifically, 21 utilized cCTA for risk stratification (7,153 patients), [30][31][32][33][34][37][38][39][40][41][42][43][44][45][46][47][54][55][56][57][58] five utilized stress echocardiography (1,892 patients), …”

Section: Search Resultsmentioning

confidence: 99%

“…There were eight studies evaluating MACE events at 12 months with overall considerable heterogeneity when pooling 41,43,46,47,50,56,59,60 . Subgroup analysis performed found a pooled cCTA rate of MACE 0.16% (95% CI = 0.04% to 0.65%) compared to 1.68% (95% CI = 0.01% to 2.6%) for stress echocardiography both with low within‐group heterogeneity (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…[54][55][56][57][58][59][60][61][62] The type of testing utilized varied in each study, and some assessed multiple modalities. Specifically, 21 utilized cCTA for risk stratification (7,153 patients), [30][31][32][33][34][37][38][39][40][41][42][43][44][45][46][47][54][55][56][57][58] five utilized stress echocardiography (1,892 patients), [50][51][52]59,60 assessed MPS (1,237 patients), 36,53,61,62 and three studies assessed exercise stress testing (521 patients). 35,48,49 Study details are listed in Table 2.…”

Section: Search Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta‐analysis

Mehta

McDonald

Hirani

et al. 2021

Academic Emergency Medicine

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Objectives Our primary objective was to describe the risk of major adverse cardiac events (MACE) at 1, 6, and 12 months after a negative coronary computed tomography angiogram (cCTA), electrocardiogram (ECG) stress test, stress echocardiography, and myocardial perfusion scintigraphy (MPS) in low‐ to intermediate‐risk patients. Methods Initially, 952 articles were identified for screening, 81 met criteria for full‐text review, and once risk of bias was assessed, 33 articles were included in this meta‐analysis. We utilized a random‐effects model to assess pooled MACE event proportion for patients undergoing evaluation of acute coronary syndrome (ACS) when risk stratified to a low‐ to intermediate‐risk category after undergoing standard testing. Heterogeneity analysis was performed using Cochrane's Q‐test and I2 statistic. Results Twenty‐one studies evaluated follow‐up at 1 month with cCTA having a 0.09% (95% confidence interval [CI] = 0.03% to 0.26%) pooled MACE compared to 0.23% (95% CI = 0.01% to 5.8%) of the exercise stress testing (p = 1). MPS and cCTA had an overall event rate of 0.15% (95% CI = 0.06% to 0.41%) at 6 months (I2 = 0%). At 12 months, a subgroup analysis found a pooled cCTA MACE of 0.16% (95% CI = 0.04% to 0.65%) compared to 1.68% (95% CI = 0.01% to 2.6%) for stress echocardiography with low within‐group heterogeneity (I2 = 0%). Subgroup analysis of cCTA with no disease versus nonobstructive disease (<50% stenosis) did not find statistical difference in the MACE at both 1 month (0.17% [95% CI = 0.04% to 0.67%] vs. 0.06% [95% CI = 0.01% to 0.34%]) and 12 months (0.44% [95% CI = 0.09% to 2.2% vs. 0.54% [95% CI = 0.19% to 1.5%]). Conclusions Patients presenting with chest pain who have a coronary CTA showing < 50% stenosis, negative ECG stress test, stress echocardiography, or stress myocardial perfusion scan in the past 12 months can be discharged without any further risk stratification if their ECG and troponin are reassuring given low MACE.

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Section: Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta‐analysis

Mehta

McDonald

Hirani

et al. 2021

Academic Emergency Medicine

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“…For patients presenting at an emergency department with chest pain, nondiagnostic ECG, and negative cardiac biomarkers, the overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SE for the diagnosis of CAD were 90%, 92%, 78% and 97%, respectively. Moreover, exercise SE had a better specificity than dobutamine SE [76].…”

Section: Diagnostic and Prognostic Accuracymentioning

confidence: 88%

Noninvasive Imaging for the Assessment of Coronary Artery Disease

Arasaratnam¹,

Ruddy²

2015

Coronary Artery Disease - Assessment, Surgery, Prevention

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Noninvasive cardiac imaging is a cornerstone of the diagnostic work-up in patients with suspected coronary artery disease (CAD), cardiomyopathy, heart failure, and congenital heart disease. It is essential for the assessment of CAD from functional and anatomical perspectives, and is considered the gate-keeper to invasive coronary angiography. Cardiac tests include exercise electrocardiography, single photon emission computed tomography myocardial perfusion imaging, positron emission tomography myocardial perfusion imaging, stress echocardiography, coronary computed tomography angiography, and stress cardiac magnetic resonance. The wide range of imaging techniques is advantageous for the detection and management of cardiac diseases, and the implementation of preventive measures that can affect the long-term prognosis of these diseases. However, clinicians face a challenge when deciding which test is most appropriate for a given patient. Basic knowledge of each modality will facilitate the decision-making process in CAD assessment.

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Does an imaging stress-test adds information to prognostic scores in patients with chest pain in the emergency department?

et al. 2018

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We evaluated the ability of a stress-test (Str-T) to improve the risk stratification based on prognostic scores in patients presenting to the ED with chest pain. Between 2008, June and 2013, December, 1082 patients with chest pain were evaluated with an imaging Str-T. With a retrospective analysis, patients were stratified according to: (1) Florence Prediction Rule as low (0-1, LR-FPR), intermediate (2-4, IR-FPR), high risk (5-6, HR-FPR), respectively, 26, 50 and 24% of patients; (2) HEART score as LR-HEART, (0-3) and HR-HEART (≥4), respectively, 36 and 64%; (3) likelihood of CAD according to NICE guidelines, 10-29% LR-NICE, 30-60% IR-NICE and > 60% HR-NICE, respectively, 12, 18 and 70%. Scores' diagnostic performance was calculated with Str-T as reference. One-month follow-up by a phone call was performed, to investigate the occurrence of new cardiovascular events. In LR and HR patients, FPR and NICE score showed sensitivity 66 vs 93%, specificity 59 vs 19% (both p < 0.001), Positive Predictive Value (PPV) 36 vs 31%, Negative Predictive Value (NPV) 83 vs 87%. Among LR-HEART patients, Str-T was positive for inducible ischemia in 53 (14%) patients and 12 (4%) of them underwent a percutaneous coronary revascularization. The Str-T was negative for inducible ischemia in 760 (70%) patients, positive in 272 (25%), inconclusive in 50 (5%); among patients in the LR and IR subgroups, incidence of CAD (1.3 and 1.6%) and the cumulative incidence of significant events at 1-month follow-up (both 1%) was very low Str-T improved prognostic scores' diagnostic performance in LR- and HR-subgroups.

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Stress echocardiography in the ED: diagnostic performance in high-risk subgroups

Cited by 6 publications

References 15 publications

Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta‐analysis

Major adverse cardiac events after emergency department evaluation of chest pain patients with advanced testing: Systematic review and meta‐analysis

Noninvasive Imaging for the Assessment of Coronary Artery Disease

Does an imaging stress-test adds information to prognostic scores in patients with chest pain in the emergency department?

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