Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with suspected acute coronary syndrome but negative troponin: a prospective randomized controlled study

Jeetley, Paramjit; Burden, Leah; Stoykova, Boyka; Senior, Roxy

doi:10.1093/eurheartj/ehl444

Cited by 77 publications

(35 citation statements)

References 24 publications

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“…Additionally, echocardiography provides information on valvular function and contractile performance that may be useful in certain clinical circumstances. Few stress echo studies have been performed in a CPU setting, and none could demonstrate significant differences in hard cardiac events at follow-up (11)(12)(13)(14)(15)(16)(17)(18)(19). These studies, although failing to demonstrate differences in negative outcomes between patients with positive or negative test results, aimed at combined end points, including soft events, such as the number of elective revascularization procedures (mostly test-driven), recurrent angina, or CAD.…”

Section: Introductionmentioning

confidence: 99%

Dipyridamole Stress Echocardiography Does Not Trigger Release of Highly-Sensitive Troponin I and T

Cervellin¹,

Robuschi²,

Scioscioli³

et al. 2014

Journal of Medical Biochemistry

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SummaryBackground: The patients with episodes of chest pain and no electrocardiographic or biomarker abnormalities are currently monitored and subjected to non-invasive testing. Stress echocardiography is one of the most often used provocative tests, being the most cost-and risk-effective imaging technique. Some concerns about this technique have been raised regarding potential drug-induced myocardial injury. Our study hence aimed to establish whether or not dipyridamole stress echocardiography elicits release of troponin I (TnI) and T (TnT), as reliable biomarkers of myocardiocyte injury. Methods: Thirty-two patients, after exclusion of ongoing acute coronary syndrome (ACS) during evaluation in the emergency department (ED), were studied with echocardiography both at the baseline and after pharmacological stress with dipyridamole. Results: All subjects had biomarkers assessment immediately before the stress-test (T1), 1 h from conclusion of the test (T2), and 6 h afterwards (T3). Cardio specific troponins were assessed with one contemporary-sensitive (TnI) and two highly-sensitive (HS) methods (HS-TnI and HS-TnT). The concentration of TnI, HS-TnI and HS-TnT did not differ throughout the three time points. At no time point the concentration of either HS-TnI or HS-TnT was significantly different among patients with negative or positive stress test.

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Section: Introductionmentioning

confidence: 99%

Dipyridamole Stress Echocardiography Does Not Trigger Release of Highly-Sensitive Troponin I and T

Cervellin¹,

Robuschi²,

Scioscioli³

et al. 2014

Journal of Medical Biochemistry

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“…This approach led to a reduced number of unnecessary coronary angiograms in comparison with a pure exercise ECG only approach or with a selective ESE approach (ESE for patients with non-diagnostic exercise ECG results) [23] . Also, ESE was superior to exercise ECG in risk stratification of patients evaluated in chest pain units, resulting in less diagnostic uncertainty, fewer referrals for further unnecessary investigation, and hence, a significant cost benefit over exercise ECG testing [24] .…”

Section: Cost-effectivenessmentioning

confidence: 99%

Exercise echocardiography

Peteiro

Bouzas‐Mosquera²

2010

WJC

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Exercise echocardiography has been used for 30 years. It is now considered a consolidated technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). Of the stress echocardiography techniques, it represents the first choice for patients who are able to exercise. Given that the cost-effectiveness and safety of stress echocardiography are higher than those of other imaging techniques, its use is likely to be expanded further. Recent research has also proposed this technique for the evaluation of cardiac pathology beyond CAD. Although the role of new technology is promising, the assessment of cardiac function relies on good quality black and white harmonic images.

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“…Although exercise stress testing alone has been shown to be effective, 8,16 the use of imaging, either myocardial perfusion imaging (MPI), 17 echocardiography, 18,19 or more advanced protocols using cardiac MRI 20 is frequently used as an alternative. Recently, evaluation with cardiac computed tomographic angiography (CTA) has emerged, in which coronary anatomy can be defined with high accuracy in a rapid fashion.…”

mentioning

confidence: 99%

“…Only a few randomized studies have been performed that compare different types of testing, and most have included relatively small numbers of patients, 12,18,19 with a few notable exceptions. 11,13 In this regard, the current study by Lim et al 22 is timely.…”

mentioning

confidence: 99%

Acute chest pain evaluation: Is there too much stress on the system?

Kontos

Kirk

2013

Journal of Nuclear Cardiology

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See related article, pp. 1002-1012Those who have followed the literature regarding the evaluation of patients with acute chest pain over the last two decades are aware of these commonly repeated facts: Over 100 million patients present to the emergency department (ED) each year, of whom approximately 6%-8% are related to chest pain or other symptoms suggestive of myocardial infarction (MI). 1The missed acute coronary syndrome (ACS) rate is estimated at 2%-4% 2,3 (although recent studies are lacking), with substantially worse outcomes than those who are recognized.2 The cost related to chest pain evaluation is significant, estimated to be in the tens of billions of dollars, 4 which has likely increased since these estimates. This high cost is in part related to the low threshold for evaluation, owing to a conservative practice to avoid litigation related to missed MI, 5 one of the largest sources of ED malpractice awards. 6In response, a variety of strategies have been developed for rapid assessment to exclude MI, 7-10 followed by provocative testing to exclude ischemia, and more recently imaging to identify significant coronary artery disease (CAD).11,12 The goal of this ''secondary'' evaluation is to identify the few remaining high risk patients among the many low risk patients (at times analogous to finding a needle in a haystack). Multiple studies have demonstrated that using a standardized protocol that included serial biomarkers and subsequent testing could reduce overall costs with similar or improved outcomes compared to standard care for evaluating low risk chest pain patients [13][14][15] As a result, this approach has become the standard of care and is often carried out in the ED or Observation Unit.Secondary testing can take numerous forms. Although exercise stress testing alone has been shown to be effective, 8,16 the use of imaging, either myocardial perfusion imaging (MPI), 17 echocardiography, 18,19 or more advanced protocols using cardiac MRI 20 is frequently used as an alternative. Recently, evaluation with cardiac computed tomographic angiography (CTA) has emerged, in which coronary anatomy can be defined with high accuracy in a rapid fashion. 11,12This frequent use of imaging may in part be related to the proportion of patients who cannot exercise, have uninterpretable ECGs, or possibly the perception that the increased sensitivity added by imaging is important. 21All of these tests have the goal of excluding myocardial ischemia as a potential cause for the patient's symptoms, although the optimal test for evaluation remains unclear.Only a few randomized studies have been performed that compare different types of testing, and most have included relatively small numbers of patients, 12,18,19 with a few notable exceptions. 11,13 In this regard, the current study by Lim et al 22 is timely. The authors compare stress MPI to a standard evaluation process of ED patients presenting with possible myocardial ischemia. Patients underwent clinical assessment with subsequent exclusion of MI using both CKM...

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Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with suspected acute coronary syndrome but negative troponin: a prospective randomized controlled study

Abstract: SEcho is superior to ExECG in the risk stratification of patients with suspected ACS but negative troponin. SEcho resulted in less diagnostic uncertainty, fewer referrals for further investigation, and hence, a significant cost benefit over ExECG.

Cited by 77 publications

References 24 publications

Dipyridamole Stress Echocardiography Does Not Trigger Release of Highly-Sensitive Troponin I and T

Dipyridamole Stress Echocardiography Does Not Trigger Release of Highly-Sensitive Troponin I and T

Exercise echocardiography

Acute chest pain evaluation: Is there too much stress on the system?

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