Identification of high-risk patients with acute coronary syndrome using point-of-care echocardiography in the ED

Frenkel, Oron; Riguzzi, Christine; Nagdev, Arun

doi:10.1016/j.ajem.2014.03.003

Cited by 20 publications

(14 citation statements)

References 6 publications

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“…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%

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: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…18 Two previous case series evaluating the use of point-of-care echocardiography by emergency department physicians concluded that echocardiography can provide a rapid detailed assessment of WMAs that may help speed clinical decisionmaking. 19,20 Detecting early WMAs may be imperative, as these occur even before electrocardiographic changes or chest pain in patients with ACS. 9 Another more recent study investigated the use of echocardiography in the evaluation of patients with ACS in the prehospital setting.…”

Section: Literature Reviewmentioning

confidence: 99%

Echocardiography in Detecting Mechanical Complications in Acute Coronary Syndrome

Harnish

Nesheiwat

Mahmood

et al. 2020

CASE

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“…The answer is yes. Studies have shown that with adequate training EPs can learn advanced echocardiography modalities, including complex and subjective assessments such as diastology and regional wall motion abnormalities (RWMA's) . When EPs’ images are reviewed by a cardiologist or a comprehensive echo is subsequently performed, a high level of concordance is obtained for severe or life‐threatening clinical findings.…”

Section: Ed Physicians Can Learn Advanced Echomentioning

confidence: 99%

“…If noted, a new RWMA in a patient with recent or ongoing chest pain increases the likelihood of an acute coronary syndrome (ACS), although this highly advanced skill is a subjective assessment. Judicious integration of echocardiographic data is required here, rather than a binary approach.…”

Section: Chest Painmentioning

confidence: 99%

Expanding our FoCUS: the utility of advanced echocardiography in the emergency department

Henry

Haji

2019

Australas J Ultrason Med

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Point-of-care ultrasound (POCUS) use is widespread amongst emergency physicians (EPs). Many sonographic modalities have proven useful in the emergency department (ED), including basic echocardiography. Progressing to more advanced echocardiography allows for improved accuracy when making time-critical diagnoses and management decisions, particularly among the sickest patients. Acquisition of this skill set by EPs is feasible and enhances patient care.

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Identification of high-risk patients with acute coronary syndrome using point-of-care echocardiography in the ED

Cited by 20 publications

References 6 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

Echocardiography in Detecting Mechanical Complications in Acute Coronary Syndrome

Expanding our FoCUS: the utility of advanced echocardiography in the emergency department

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