The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

Russo, Vincenzo; Sportoletti, Camilla; Scalas, Giulia; Attinà, Domenico; Buia, Francesco; Niro, Fabio; Modolon, Cecilia; Luca, Carlo De; Monteduro, Francesco; Lovato, Luigi

doi:10.1007/s10140-021-01911-8

Cited by 11 publications

(4 citation statements)

References 19 publications

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“…This modality may be beneficial in certain cases due to the ability to identify both cardiac and non-cardiac conditions in equivocal cases of chest pain. TRO-CT simultaneously examines the coronary arteries, thoracic aorta, and pulmonary artery, and may detect coronary lesions, aortic dissection, and pulmonary embolism respectively [ 49 ]. In one study, TRO-CT detected significant noncoronary diagnosis in about 9% of patients admitted the ER with chest pain, including findings that would not be identified in cardiac CT modality [ 50 ].…”

Section: Diagnostic Workup and Suggested Algorithmmentioning

confidence: 99%

Takotsubo Syndrome in the Emergency Room — Diagnostic Challenges and Suggested Algorithm

Moady¹,

Rubinstein²,

Mobarki³

et al. 2022

Rev. Cardiovasc. Med.

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Takotsubo syndrome is an important condition to consider among patients with acute chest pain in the emergency room. It often mimics acute coronary syndrome since chest pain and ECG changes are key features in both conditions. The hallmark of takotsubo syndrome is transient left ventricular dysfunction (characterized by apical ballooning) followed by complete echocardiographic recovery in most cases. Although most patients exhibit a benign course, lethal complications may occur. The use of hand-held point-of-care focused cardiac ultrasound may be helpful for early identification of takotsubo syndrome and distinguishing it from acute coronary syndrome and other cardiovascular emergencies. Emergency room physicians should be familiar with typical and atypical presentations of takotsubo syndrome and its key electrocardiographic changes. The approach in the emergency room should be based on a combination the clinical presentation, ECG, and handheld echocardiography device findings, rather than a single electrocardiographic algorithm.

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Section: Diagnostic Workup and Suggested Algorithmmentioning

confidence: 99%

Takotsubo Syndrome in the Emergency Room — Diagnostic Challenges and Suggested Algorithm

Moady¹,

Rubinstein²,

Mobarki³

et al. 2022

Rev. Cardiovasc. Med.

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“…In addition, the "triple rule-out protocol" can assess other causes of life-threatening chest pain beside coronary ischemia, using the 64-slice MDCT device, with a single breath hold (2,11,12) . This protocol has been widely used as it is not invasive compared to the conventional cardiac catheterization, and it could also assess other intrathoracic structures in a single scan (13) .…”

Section: Introductionmentioning

confidence: 99%

“Triple Rule Out” CT scan in Emergency Department Patients

2023

The Egyptian Journal of Hospital Medicine

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Background: Although conventional coronary angiography is the gold standard tool of diagnosing coronary artery disease (CAD), it is an invasive procedure, and it can miss non-coronary causes of acute chest pain. Triple role out CT has emerged as a promising tool for assessment of such cases. Herein, we present our experience in comparing "triple out CT" as a diagnostic tool for acute chest pain patients. Objective: The aim of the current study was to assess the validity and efficacy of triple rule-out CT in diagnosis of different vascular causes of chest pain in the Emergency Department. Patients and methods: The data of 50 patients with an intermediate risk for CAD were retrospectively reviewed. All of them underwent the triple out protocol, and when coronary cause was established, conventional angiography was done. Results: CT angiography (CTA) revealed CAD in 29 (58%) subjects, while non-coronary disease was detected in 12 (24%) patients. The remaining nine subjects had negative CTA study. In the patients diagnosed with CAD, most of them had severe disease (82.8%), whereas the remaining five patients had moderate one. Findings rather than CAD included pulmonary embolism, mediastinal mass, acute aortic disease, pulmonary disease, hernia, and pulmonary artery aneurysm. There was a significant relation agreement between CTA and cardiac catheterization regarding the severity of CAD (P<0.001). Conclusion: Triple out CT could be a surrogate diagnostic modality for patients with acute chest pain, even when CAD is suspected. It can yield comparable results compared to the conventional coronary angiography. Therefore, its application is widely recommended in low-source emergency settings.

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“…Over 8 million people visit emergency departments owing to chest pain yearly [ 1 , 2 ]. Chest pain remains a major diagnostic challenge in emergency departments [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Dedicated CCTA Followed by High-Pitch Scanning versus TRO-CT for Contrast Media and Radiation Dose Reduction: A Retrospective Study

Wang

Wang²,

Zheng³

et al. 2022

Diagnostics

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We aimed to compare dedicated coronary computed tomography angiography (CCTA) followed by high-pitch scanning and triple-rule-out computed tomography angiography (TRO-CTA) in terms of radiation dose, contrast media (CM) use, and image quality. Patients with acute chest pain were retrospectively enrolled and assigned to group A (n = 55; scanned with dedicated CCTA followed by high-pitch scanning) or group B (n = 45; with TRO-CTA). Patient characteristics, radiation dose, CM use, and quantitative parameters (CT value, image noise, signal-to-noise ratio, contrast-to-noise ratio, and image quality score) of pulmonary arteries (PAs), thoracic aortae (TAs), and coronary arteries (CAs) were compared. The total effective dose was significantly lower in group A (6.25 ± 2.94 mSv) than B (8.93 ± 4.08 mSv; p < 0.001). CM volume was significantly lower in group A (75.7 ± 8.9 mL) than B (95.0 ± 0 mL; p < 0.001). PA and TA image quality were significantly better in group B, whereas that of CA was significantly better in group A. Qualitative image scores of PA and TA scans rated by radiologists were similar, whereas that of CA scans was significantly higher in group A than B (p < 0.001). Dedicated CCTA followed by high-pitch scanning demonstrated lower radiation doses and CM volume without debasing qualities of PA, TA, and CA scans than did TRO-CTA.

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The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

Cited by 11 publications

References 19 publications

Takotsubo Syndrome in the Emergency Room — Diagnostic Challenges and Suggested Algorithm

Takotsubo Syndrome in the Emergency Room — Diagnostic Challenges and Suggested Algorithm

“Triple Rule Out” CT scan in Emergency Department Patients

Dedicated CCTA Followed by High-Pitch Scanning versus TRO-CT for Contrast Media and Radiation Dose Reduction: A Retrospective Study

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