Rationale and Design of a Randomized Trial Comparing Initial Stress Echocardiography versus Coronary <scp>CT</scp> Angiography in Low‐to‐Intermediate Risk Emergency Department Patients with Chest Pain

Levsky, Jeffrey M.; Haramati, Linda B.; Taub, Cynthia C.; Spevack, Daniel M.; Menegus, Mark; Travin, Mark I.; Vega, Shayna; Lerer, Rikah; Brown-Manhertz, Durline; Hirschhorn, Esther; García, Mario J.

doi:10.1111/echo.12464

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…In the Appropriate Use Criteria for echocardiography guidelines, echocardiography is appropriate for the initial evaluation of patients with myocardial ischemia/infarction, valve disease, heart failure, cardiomyopathy, structure, and function, or for re-evaluation of these patients with a change in clinical status. The assessment of inferior vena cava size and collapsibility using echocardiography should allow for the prediction of readmission risk in patients with heart failure, as inadequate assessment of volume status leading to persistent congestion is an important contributing factor to rehospitalization ( 7 – 9 , 33 ). Hyperlipidemia is strongly associated with cerebrovascular disease and coronary artery disease ( 34 – 36 ).…”

Section: Discussionmentioning

confidence: 99%

“…Echocardiography is usually the preferred method for the assessment of the size, segmental wall motion, and function of the left ventricle, the hemodynamics of the valve, and pulmonary pressure. Besides, it is also a useful tool in the diagnosis of myocardial infarction, heart failure, and congenital heart disease ( 7 – 9 , 40 ). Advanced echocardiography (speckle tracking echocardiography and 3D echocardiography vs. 2D conventional echocardiography) is becoming more widely available and it may influence therapeutic decisions even more than conventional approaches ( 41 , 42 ).…”

Section: Discussionmentioning

confidence: 99%

“…Exercise, dobutamine, adenosine, or dipyridamole stress echocardiography can be used to assess coronary artery disease (5,6). Additionally, physicians will be able to better grasp the status of patients with CVD and formulate more appropriate treatment strategies, resulting in fewer unnecessary admissions (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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A nomogram for predicting echocardiogram prescription in outpatients: an analysis of the NAMCS database

Liu,

Deng,

Wang

et al. 2023

Front. Cardiovasc. Med.

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Background and objectiveCardiovascular disease is the leading cause of morbidity and mortality globally. Echocardiography is a commonly used method for assessing the condition of patients with cardiovascular disease. However, little is known about the population characteristics of patients who are recommended for echocardiographic examinations.MethodsThe National Ambulatory Medical Care Survey was a cross-sectional survey previously undertaken in the USA. In this study, publicly accessible data from the National Ambulatory Medical Care Survey database (for 2007–2016 and 2018–2019; data for 2017 was not published) were utilized to create a nomogram based on significant risk predictors. The study was performed in accordance with the relevant guidelines and regulations stipulated in the National Ambulatory Medical Care Survey database. Patients were randomly assigned to one of two groups: training cohort or validation cohort. The latter was used to assess the reliability of the prediction nomogram. Decision curve analysis was performed to evaluate the net benefit. Propensity score matching analysis was used to evaluate the relevance of echocardiography to clinical decision-making.ResultsA total of 217,178 outpatients were enrolled. Multivariable logistic regression analysis demonstrated that hypertension, hyperlipidemia, coronary artery disease/ischemic heart disease/history of myocardial infarction, congestive heart failure, major reason for visit, metropolitan statistical area, cerebrovascular disease/history of stroke or transient ischemic attack, previously assessed, insurance, referred, diagnosis, and reason for visit were all predictors of echocardiogram prescription in outpatients. The reliability of the predictive nomogram was confirmed in the validation cohort. After propensity score matching, there was a significant difference in new cardiovascular agent prescriptions between the echocardiogram and no echocardiogram groups (P < 0.01).ConclusionIn this cohort study, a nomogram based on the characteristics of outpatients was developed to predict the possibility of prescribing echocardiography. The echocardiogram group was more likely to be prescribed new cardiovascular agents. These findings may contribute to providing information about the gap between actual utilizations and guidelines and the actual outpatient practice, as well as meeting the needs of outpatients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A nomogram for predicting echocardiogram prescription in outpatients: an analysis of the NAMCS database

Liu,

Deng,

Wang

et al. 2023

Front. Cardiovasc. Med.

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Stress Echocardiography Versus Cardiac CT

Wijns¹

2015

Stress Echocardiography

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Diagnostic Strategies for the Evaluation of Chest Pain

Fordyce

Newby

Douglas

2016

Journal of the American College of Cardiology

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SCOT-HEART and PROMISE represent the 2 largest and most comprehensive cardiovascular imaging outcome trials in patients with stable chest pain, and provide significant insights into patient diagnosis, management, and outcomes. These trials are particularly timely, given the well-recognized knowledge gaps and widespread use of noninvasive imaging. The overall goal of this review is to distill the data generated from these 2 pivotal trials to better inform the practicing clinician in the selection of noninvasive testing for stable chest pain. Similarities and differences between SCOT-HEART and PROMISE are highlighted, and clinical and practical implications discussed. Both trials show that CCTA should have a greater role in the diagnostic pathway of patients with stable chest pain.

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Rationale and Design of a Randomized Trial Comparing Initial Stress Echocardiography versus Coronary CT Angiography in Low‐to‐Intermediate Risk Emergency Department Patients with Chest Pain

Cited by 5 publications

References 33 publications

A nomogram for predicting echocardiogram prescription in outpatients: an analysis of the NAMCS database

A nomogram for predicting echocardiogram prescription in outpatients: an analysis of the NAMCS database

Stress Echocardiography Versus Cardiac CT

Diagnostic Strategies for the Evaluation of Chest Pain

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