Comparison between 2-dimensional echocardiography and myocardial perfusion imaging in the emergency department in patients with possible myocardial ischemia

Kontos, Michael C.; Arrowood, James A.; Jesse, Robert L.; Ornato, Joseph P.; Paulsen, Walter H.P.; Tatum, James L.; Nixon, J.V.

doi:10.1016/s0002-8703(98)70022-5

Cited by 42 publications

(25 citation statements)

References 34 publications

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“…15 Studies have also shown that patients with acute chest pain who have resting wall motion abnormalities are at much higher risk for cardiac events than those who do not. 11,15 In our study only two patients had this finding. While one refused further testing, the other had significant left main CAD and required urgent coronary artery bypass surgery.…”

Section: Discussionmentioning

confidence: 48%

Emergency Department Evaluation of Chest Pain Using Exercise Stress Echocardiography

Buchsbaum

Marshall

Levine

et al. 2001

Academic Emergency Medicine

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Abstract. Objective: Patients with a low risk of coronary artery disease (CAD) presenting to the emergency department (ED) with chest pain pose a diagnostic dilemma because a small percentage will suffer an acute myocardial infarction (MI) and sudden death. The authors conducted this study to determine whether exercise stress echocardiography (ESE) could be used to further support the safe discharge of these low-risk patients. Methods: A convenience sample of patients Ն30 years of age without a prior cardiac history who presented to an academic community hospital with chest pain, normal initial creatine kinase, and electrocardiography without ischemic changes underwent ESE within 6 Ϯ 1.7 hours (mean Ϯ SD). Abnormal ESE was defined as regional wall motion abnormality at rest or after exercise. The ED disposition and three-and six-month follow-up for cardiac events were recorded. This was a prospective observational cohort study. Results: Of a total of 149 eligible patients, 145 completed the study. The mean age (ϮSD) was 47 Ϯ 9 years; 56% were male. No adverse events were noted during ESE. Seven patients (5%) had abnormal ESE (2 with rest wall motion abnormalities and 5 with exercise-induced wall motion abnormalities). Five of the seven underwent cardiac catheterization; three had CAD. All patients received telephone follow-up at three months and six months. Of the 138 patients with a normal ESE, all were free of cardiac events at three months. One patient had a non-Q-wave MI at six months (negative predictive value = 99.3%, 95% CI = 97.8% to 100%). Conclusions: Exercise stress echocardiography can be used to evaluate low-risk chest pain patients in the ED. Patients with a normal ESE may be considered for discharge with minimal risk of sequelae.

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Section: Discussionmentioning

confidence: 48%

Emergency Department Evaluation of Chest Pain Using Exercise Stress Echocardiography

Buchsbaum

Marshall

Levine

et al. 2001

Academic Emergency Medicine

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“…Other noninvasive diagnostic imaging modalities exist that are useful in the evaluation of patients presenting to the ED with acute chest pain, including contrast echocardiography, 17,18 single-photon emission CT-myocardial perfusion imaging, 19,20 and most recently, coronary CT angiography. 10,21,22 Although these imaging modalities are useful in excluding ACS (because of their high negative predictive value), they are not entirely helpful in identifying patients with true ACS and thereby refining patient management in those who need more aggressive treatment, because they are limited by low to intermediate positive predictive values.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Magnetic Resonance With T2-Weighted Imaging Improves Detection of Patients With Acute Coronary Syndrome in the Emergency Department

et al. 2008

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Background-Cardiac magnetic resonance (CMR) imaging permits early triage of patients presenting to the emergency department with acute chest pain but has been limited by the inability to differentiate new from old myocardial infarction. Our objective was to evaluate a CMR protocol that includes T2-weighted imaging and assessment of left ventricular wall thickness in detecting patients with acute coronary syndrome in the emergency department. Methods and Results-In this prospective cohort observational study, we enrolled patients presenting to the emergency department with acute chest pain, negative cardiac biomarkers, and no ECG changes indicative of acute ischemia. The CMR protocol consisted of T2-weighted imaging, first-pass perfusion, cine function, delayed-enhancement magnetic resonance imaging, and assessment of left ventricular wall thickness. The clinical outcome (acute coronary syndrome) was defined by review of clinical charts by a consensus panel that used American Heart Association/American College of Cardiology guidelines. Among 62 patients, 13 developed acute coronary syndrome during the index hospitalization. The mean CMR time was 32Ϯ8 minutes. The new CMR protocol (with the addition of T2-weighted and left ventricular wall thickness) increased the specificity, positive predictive value, and overall accuracy from 84% to 96%, 55% to 85%, and 84% to 93%, respectively, compared with the conventional CMR protocol (cine, perfusion, and delayed-enhancement magnetic resonance imaging

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“…Echocardiograms were considered positive if they showed 1) hypokinesis or akinesis of two or more contiguous segments, 2) abnormal wall motion, and 3) global hypokinesis and systolic disfunction. 21,22 Each of the above evaluation studies of pathophysiological parameters of heart functions was interpreted by two experienced specialists blinded to the patient's clinical status and outcome.…”

Section: Populationmentioning

confidence: 99%

Progressive chronic Chagas heart disease ten years after treatment with anti-Trypanosoma cruzi nitroderivatives.

Lauria-Pires

Braga²,

A³

et al. 2000

Am J Trop Med Hyg

116

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Abstract. A randomized ten-year follow-up study involving 91 Chagas patients and 41 uninfected controls was undertaken to determine the effectiveness of nitroderivative therapy. Anti-Trypanosoma cruzi antibodies were consistently lower one year after treatment than 10 years thereafter (P Ͻ 0.001). The blood of all treated and 93.7% of untreated Chagas patients yielded polymerase chain reaction (PCR) product from probes annealing to T. cruzi nuclear DNA, indicating active infection. Competitive PCR showed means Ϯ standard deviations of 20.1 Ϯ 22.6 T. cruzi/ml of blood from untreated and 13.8 Ϯ 14.9 from treated Chagas patients, but the differences between means were not statistically significant (P Ͼ 0.05). Electrocardiograms recorded a gamut of alterations several-fold more frequent in Chagas patients, regardless of treatment, than in uninfected controls (P Ͻ 0.001). These results show that nitroderivative therapy for T. cruzi infections is unsatisfactory and cannot be recommended since it fails to eradicate the parasite or change the progression of heart disease in chronic Chagas patients.

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Comparison between 2-dimensional echocardiography and myocardial perfusion imaging in the emergency department in patients with possible myocardial ischemia

Cited by 42 publications

References 34 publications

Emergency Department Evaluation of Chest Pain Using Exercise Stress Echocardiography

Emergency Department Evaluation of Chest Pain Using Exercise Stress Echocardiography

Cardiac Magnetic Resonance With T2-Weighted Imaging Improves Detection of Patients With Acute Coronary Syndrome in the Emergency Department

Progressive chronic Chagas heart disease ten years after treatment with anti-Trypanosoma cruzi nitroderivatives.

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