Early Echocardiography Can Predict Cardiac Events in Emergency Department Patients With Chest Pain

Efficacy of Myocardial Contrast Echocardiography in the Diagnosis and Risk Stratification of Acute Coronary Syndrome

“…Acute myocardial infarction was confirmed if Ն2 of the following were present: symptoms consistent with myocardial ischemia, development of Q wave, or a creatine kinase-MB increase Ͼ2 times the upper limit of normal (10 ng/ml). 6,7 Acute coronary syndrome was confirmed if there was development of acute myocardial infarction or documentation of significant coronary artery disease that required urgent revascularization. 8,9 Myocardial contrast echocardiography: Intravenous MCE was performed with a Sonos 5500 instrument (Philips Medical Imaging, Andover, Massachusetts) with harmonic Figure 1.…”

“…Echocardiography has been reported to be a more sensitive tool than electrocardiography in diagnosing and excluding acute myocardial infarction 7,17 but has limitations for the diagnosis of unstable angina. In this study, evaluation of myocardial perfusion by MCE substantially improved the diagnostic accuracy of echocardiographic evaluation for acute myocardial infarction and unstable angina.…”

The role of non-invasive imaging in patients with suspected acute coronary syndrome

“…In the acute setting, echocardiography is useful in that it can identify wall-motion abnormalities that may be the consequence of acute myocardial ischaemia in patients with non-diagnostic ECG changes and ongoing chest pain. In this context, echocardiography has a high sensitivity (.90%) and high negative predictive value (.95%) for myocardial infarction and ischaemia [24][25][26]. However, ACS may occur without regional wall-motion abnormality, and the specificity of echocardiography may be as low as 53% [25].…”

Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?

“…Multiple studies, 56 including 2 prospective, randomized, controlled clinical trials, 27,67 have shown clinical utility and effectiveness, 27,66,67,72,73 with very high negative predictive values and clear impact on triage decision-making. The ERASE chest pain study randomly assigned 2456 patients to a strategy of either usual ED care or with a supplemental resting Tc-99m sestamibi scan.…”

“…77 In contrast, SPECT MPI has been shown to be a cost-effective tool in the early detection of ischemic heart disease in patients with chest pain, contributing substantially to their risk stratification. 56 When used for acute chest pain syndromes, costeffectiveness of rest SPECT MPI has been shown in several studies 27,67,72,78 including a controlled, multicenter trial with true cost data. 21 Similarly, dobutamine-atropine echocardiography 70 as well as contrast echocardiography 65,79 have both been shown to be cost effective in ED patients by reducing admissions, length of stay, and downstream resource utilization.…”