Utility of echocardiography for the early assessment of patients with nondiagnostic chest pain

Sasaki, Hiroyuki; Charuzi, Yzhar; Beeder, Clain; Sugiki, Yuji; Lew, Allan S.

doi:10.1016/0002-8703(86)90512-0

Cited by 61 publications

(25 citation statements)

References 13 publications

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“…However, a previous study showed that TTE was not useful for detecting patients with significant CAD without infarction when performed after resolution of chest pain [8].…”

Section: Introductionmentioning

confidence: 95%

Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

Lee¹,

Chang²,

Cho³

et al. 2015

Int J Cardiovasc Imaging

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Left ventricular strain echocardiography is reported to be more sensitive in detecting myocardial ischemia than conventional transthoracic echocardiography (TTE). We evaluated the usefulness of 2D strain analysis for the assessment of acute chest pain in emergency department (ED). Patients presenting to ED with acute chest pain were recruited. Patients with ST-elevation myocardial infarction, known coronary artery disease (CAD), non-ischemic cardiomyopathy, or non-cardiac chest pain were excluded. The pretest probability of CAD and TTEs were evaluated in all patients. TTEs included visual assessments of regional wall motion abnormality (RWMA) and analysis of global and regional longitudinal strain (GLS and RLS). The diagnosis of CAD and the occurrence of cardiac events during 1 month after ED visit were reviewed. Cardiac events were observed in 25% of total 104 patients, and CAD was detected in 36% of 69 patients with coronary imaging tests. Compared to RWMA, RLS showed higher sensitivity (sensitivity/specificity = 64/89 vs. 92/77%) with similar diagnostic accuracy (79.7 vs. 82.6%, p = 0.791) for CAD. RLS also demonstrated better diagnostic performance than either GLS (sensitivity/specificity = 92/57%) or pretest probability (sensitivity/specificity = 72/64 %). Similarly, RLS had the higher predictive value for 1-month cardiac events. In multivariable analyses including pretest probability, LVEF, RWMA, cardiac enzyme, GLS, and RLS; only pretest probability (OR 1.91, 95% CI 1.22-2.99, p = 0.005) and RLS (OR 25.42, 95 % CI 1.84-342.04, p = 0.016) independently predicted CAD. Strain echocardiography appears to be effective in diagnosing CAD and predicting future events with high sensitivity and negative predictive value in acute chest pain patients visiting ED.

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“…However, a previous study showed that TTE was not useful for detecting patients with significant CAD without infarction when performed after resolution of chest pain [8].…”

Section: Introductionmentioning

confidence: 95%

Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

Lee¹,

Chang²,

Cho³

et al. 2015

Int J Cardiovasc Imaging

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“…They concluded that echocardiography “can confirm the diagnosis, show the location and extent of the dissection, and demonstrate the entry tear, aortic insufficiency and any pericardial effusion” and that “surgery can be done based on a diagnosis made only in the emergency room”. The utility of echocardiography in the diagnosis of aortic dissection has been confirmed in numerous other recent reports 118,120,121,129 . An intimal flap (the most sensitive sign of dissection), localised aortic dilatation and true and false lumens are also well demonstrated by echocardiography.…”

Section: Emergency Echocardiographymentioning

confidence: 70%

“…This is particularly so in patients with either normal, equivocal or uninterpretable ECGs (left bundle branch block, paced rhythm) 111,123,124,126 . Ischaemic myocardium develops regional wall motion abnormalities (RWMAs) within minutes of occlusion of the supplying coronary artery 128,129 , and certainly much sooner than the development of either ECG changes or ischaemic chest pain 6,130 . These RWMAs are generally easily detected with standard two dimensional (2D) echocardiography with a sensitivity of approximately 90% 127,128,131 , this being much higher than the sensitivity of standard ECG at the time of presentation.…”

Section: Emergency Echocardiographymentioning

confidence: 99%

Ultrasound in emergency medicine

Kruk

1994

Emergency Medicine

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Ultrasound is a safe, non‐invasive portable imaging modality, applicable to many areas of emergency medicine. Its use in emergencies such as suspected ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy, haemoperitoneum secondary to blunt abdominal trauma and cardiac tamponade is well established. Its efficacy in such diverse conditions as acute appendicitis, gallstones, renal stones and urinary obstruction, obstetric and gynaecological conditions, deep venous thrombosis, scrotal pain and soft tissue foreign body localisation has also been demonstrated. Echocardiography is particularly useful in the investigation of aortic dissection, ischaemic heart disease, suspected pericardial effusion and cardiothoracic trauma. Emergency physicians have been successfully trained in the technique in other countries. The time is right for Australasian emergency physicians to become trained in ultrasonography, use the technique in daily practice and share this knowledge with other emergency physicians and trainees.

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“…Current stress testing modalities are limited in their ability to detect functional myocardial changes prior to the manifestation of systolic abnormalities. Conventional echocardiography is known to be useful in ED for detection of myocardial infarction, its assessment has generally been limited to the identification of ischemia as a stress-induced worsening of myocardial contractility when compared to baseline 10). The introduction of tissue Doppler imaging have shown that the diagnostic accuracy of strain echocardiography in patients with chest pain is superior to that of visually accessed RWMA by 2D echocardiography 11)12).…”

Section: Discussionmentioning

confidence: 99%

Role of Quantitative Wall Motion Analysis in Patients with Acute Chest Pain at Emergency Department

Kim

Park

2017

J Cardiovasc Ultrasound

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BackgroundEvaluation of acute chest pain in emergency department (ED), using limited resource and time, is still very difficult despite recent development of many diagnostic tools. In this study, we tried to determine the applicability of new semi-automated cardiac function analysis tool, velocity vector imaging (VVI), in the evaluation of the patients with acute chest pain in ED.MethodsWe prospectively enrolled 48 patients, who visited ED with acute chest pain, and store images to analyze VVI from July 2005 to July 2007.ResultsIn 677 of 768 segments (88%), the analysis by VVI was feasible among 48 patients. Peak systolic radial velocity (Vpeak) and strain significantly decreased according to visual regional wall motion abnormality (Vpeak, 3.50 ± 1.34 cm/s for normal vs. 3.46 ± 1.52 cm/s for hypokinesia, 2.51 ± 1.26 for akinesia, p < 0.01; peak systolic radial strain -31.74 ± 9.15% fornormal, -24.33 ± 6.28% for hypokinesia, -20.30 ± 7.78% for akinesia, p < 0.01). However, the velocity vectors at the time of mitral valve opening (MVO) were directed outward in the visually normal myocardium, inward velocity vectors were revealed in the visually akinetic area (VMVO, -0.85 ± 1.65 cm/s for normal vs. 0.10 ± 1.46 cm/s for akinesia, p < 0.001). At coronary angiography, VMVO clearly increased in the ischemic area (VMVO, -0.88+1.56 cm/s for normal vs. 0.70 + 2.04 cm/s for ischemic area, p < 0.01).ConclusionRegional wall motion assessment using VVI showed could be used to detect significant ischemia in the patient with acute chest pain at ED.

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Utility of echocardiography for the early assessment of patients with nondiagnostic chest pain

Cited by 61 publications

References 13 publications

Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

Ultrasound in emergency medicine

Role of Quantitative Wall Motion Analysis in Patients with Acute Chest Pain at Emergency Department

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