Evaluation of the performance of echocardiography in acute coronary syndrome patients during their stay in coronary units

Ruiz-Bailén, Manuel; Romero-Bermejo, Francisco José; Ramos-Cuadra, José Ángel; Rucabado-Aguilar, Luis; Chibouti-Bouichrat, Karim; Castillo-Rivera, Ana; Pintor-Mármol, Antonio; Expósito-Ruíz, Manuela; García, María Isabel Ruiz; Dolores-Pola-Gallego-de-Guzmán, María; Gómez-Jiménez, Javier; Torres-Ruiz, Juan Miguel; Ulecia-Martinez, M. A.

doi:10.3109/17482941.2010.538697

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…By contrast, the majority of patients, about 92% of all CPU patients, did not show initial STEs and were triaged to NSTE-ACS or a low likelihood for ACS pathways, both representing the main target of further noninvasive imaging risk stratification. In contrast to previous studies showing that TTE evaluation is not yet commonly used in NSTE-ACS patients, even in specialized units, the corresponding subsets in our registry received early TTE evaluation in approximately 75% of the NSTE-ACS patients and in about 50% of the patients without ACS [9,12]. Interestingly, and in contrast to self-referral, referral by an EMS turned out to be another independent variable for early TTE.…”

Section: Discussioncontrasting

confidence: 42%

“…In German CPUs, these procedures also comprise standards in noninvasive imaging methods including echocardiography with TTE evaluation as a minimum requirement for at least unstable NSTE-ACS patients [4]. So far, echocardiography is still the first-line imaging modality in triaging cardiac disorders due to its nearly universal availability, potential use at the bedside and low cost [8,9,10,11,12,19,20,21]. Beside its mainstream ability of determining global and regional LV function as well as valvular morphology and function in real-time within minutes, its diagnostic impact within the CPU setting can be further enhanced by, for example, strain, tissue-Doppler, perfusion or speckle-track analysis [22,23,24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Due to its rapid and common availability, transthoracic echocardiography (TTE) represents the most important noninvasive cardiac imaging technique in the CPU [8,9,10,11,12,13]. The current guidelines of the European Society of Cardiology recommend TTE in all ACS patients presenting without persistent ST-segment elevation, i.e.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

et al. 2016

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Objectives: To analyze the current usage of transthoracic echocardiography (TTE) as a rapid, noninvasive tool in the early stratification of acute chest pain in certified German chest pain units (CPUs). Methods: A total of 23,997 patients were enrolled. Analyses comprised TTE evaluation rates in relation to clinical presentation, risk profile, left ventricular impairment, final diagnosis and invasive management. Critical times were assessed. Multivariable analyses for independent determinants for the use of TTE were performed. Results: TTE evaluation was available in CPUs in 70.1% of cases. It was associated with lower rates of invasive management in unstable angina pectoris (UAP) and with higher rates in patients with initially suspected non-cardiac origin of symptoms and/or reduced systolic function (p < 0.05). Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was an independent determinant favoring TTE evaluation [NSTE-myocardial infarction: odds ratio (OR) 1.62; UAP: OR 1.34; p < 0.001 for both]. Clinical signs of heart failure (OR 1.31; p < 0.001), referral by emergency medical service (OR 1.18; p < 0.001) and kidney failure (OR 1.16; p < 0.05) were independently associated with higher TTE rates. TTE did not delay door-to-balloon times. Conclusions: About two thirds of the patients admitted to certified CPUs received TTE evaluation, with the highest rates being in ACS patients, and thereby providing diagnostic information supporting or refuting further invasive management.

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Section: Discussioncontrasting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

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The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

et al. 2016

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“…TEE is conventionally used to evaluate acute conditions in the ICU. TTE, on the other hand, has generally received less attention and may remain underused even in medical ICUs [ 8 ]. Although TEE is a safe procedure with a complication rate of 0.18% to 2.8% [ 9 ], it is an invasive procedure [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Critical Care Echocardiography as a Routine Procedure for the Detection and Early Treatment of Cardiac Pathologies

et al. 2020

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Transthoracic and transesophageal echocardiography are important investigations in the intensive care unit (ICU) to diagnose acute cardiac pathologies and assess the haemodynamic status. Recommendations for critical care echocardiography (CCE) have been published recently, but these still lack an evidence-based foundation. It is not known if performing transthoracic echocardiography (TTE) on a routine basis instead of only when required in acute cases is feasible or clinically useful. In this single-centre prospective observational study, we routinely performed TTE on 111 consecutive non-cardiological, non-cardiothoracic surgical ICU patients in two surgical ICUs in a tertiary care facility. Significant cardiac pathologies were detected in 82 (76.6%) and critical cardiac pathologies in 33 (30.8%) of the 107 patients. The most common critical cardiac pathologies were sPAP > 50 mmHg (19.63%), tricuspid annular plane systolic excursion ≤ 13 mm (9.4%), grade III diastolic dysfunction (8.4%), severe tricuspid valve insufficiency (5.6%) and left ventricular ejection fraction (LV-EF) ˂ 30% (4.7%). Some of the most commonly found cardiac pathologies are not well emphasised in current recommendations and training programs. We observed a progression of the cardiac pathologies previously described in 41 of the patients (91.1%). Patients with echocardiographic abnormalities had a significant survival disadvantage in the ICU. By performing CCE routinely, we observed the range and prevalence of cardiac pathologies that can be detected by echocardiography in critically ill patients. We recommend routine transthoracic CCE in ICU patients for early detection of cardiac pathologies and to help inform early intervention regimens, since cardiac conditions carry a significant survival disadvantage for the ICU patient.

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“…In spite of this, it continues being an underused diagnostic method, even in the coronary units [1]. …”

Section: Introductionmentioning

confidence: 99%

Echocardiographic Hemodynamic Monitoring in the Critically Ill Patient

Romero-Bermejo¹,

Ruiz-Bailén²,

Guerrero-De-Mier³

et al. 2011

CCR

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Echocardiography has shown to be an essential diagnostic tool in the critically ill patient's assessment. In this scenario the initial fluid therapy, such as it is recommended in the actual clinical guidelines, not always provides the desired results and maintains a considerable incidence of cardiorrespiratory insufficiency. Echocardiography can council us on these patients' clinical handling, not only the initial fluid therapy but also on the best-suited election of the vasoactive/inotropic treatment and the early detection of complications. It contributes as well to improving the etiological diagnosis, allowing one to know the heart performance with more precision. The objective of this manuscript is to review the more important parameters that can assist the intensivist in theragnosis of hemodynamically unstable patients.

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Evaluation of the performance of echocardiography in acute coronary syndrome patients during their stay in coronary units

Cited by 7 publications

References 22 publications

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

Critical Care Echocardiography as a Routine Procedure for the Detection and Early Treatment of Cardiac Pathologies

Echocardiographic Hemodynamic Monitoring in the Critically Ill Patient

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