Assessment of Patients With Low-risk Chest Pain in the Emergency Department: Head-to-Head Comparison of Exercise Stress Echocardiography and Exercise Myocardial SPECT

Comparison of exercise electrocardiogram and exercise echocardiography in intermediate-risk chest pain patients

“…The technique has been proposed in intermediate-risk chest pain patients characterized by nondiagnostic first-line evaluation for coronary artery disease. In these patients, with a substantial incidence of adverse coronary events, the conventional ST-segment analysis has shown poor diagnostic value [1,17,23,26]. The present study provides information to support evidence that a normal result of the novel ex-ECG was statistically comparable with ex-Echo in recognizing patients at "low-risk" for short-term cardiac events.…”

“…Chest pain was characterized with a validated chest pain score which takes into account pain characteristics (crushing, pressing, heaviness = 3; sticking, pleuritic, pinprick = 1), localization (substernal or precordial = 3; epigastric, left chest, neck, lower jaw = 1), radiation (as arm, shoulder, back, neck, or lower jaw = 1; absence = 0), associated symptoms (as dyspnea, nausea, diaphoresis = 2; absence = 0), and recurrence in the previous 48 hours (yes = 3, no = 0) [16,17]. The selected patients presented a pretest likelihood of coronary artery disease between 15% and 85% calculated using a model based on age, sex, smoking, diabetes, hyperlipidemia, baseline ECG abnormalities, type of chest pain, and history of myocardial infarction [18,19].…”

64-multislice computed tomography in consecutive patients with suspected or proven coronary artery disease: Initial single center experience

“…Most of them are based on indirect changes of ECG, wall motion and perfusion during provocative tests reflecting a mismatch between myocardial oxygen demand and supply. All these tests have shown high correlation with angiography and, more importantly, high prognostic value to predict future coronary events [13]. Still, individual patients must often undergo multiple expensive time-consuming non-invasive tests and because of inconclusive or conflicting results or persistent worrisome symptoms, eventually undergo coronary angiography.…”

“…Arterial wall calcification was graded as follows: (1) absent, if there was no calcium; (2) moderate, small and isolated wall calcifications; (3) severe, extensive wall calcification throughout the segment of interest. The total amount of calcium in the coronary tree was quantified using the score system originally developed by Agatston (Agatson Score Equivalent ASE) [13] after excluding stents and clips from the overall score.…”

Stress echocardiography for the detection and assessment of coronary artery disease

“…64 For such patients, exercise or dobutamine stress echocardiography can be safely performed with very good diagnostic accuracy. 65,66 Dobutamine stress echocardiography has been shown to be particularly useful for detecting CAD in patients with LBBB. 67,68 Risk Stratification of CAD Stress echocardiography permits effective prediction of the risk of future cardiovascular events for patients with known or suspected CAD.…”