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Two-dimensional strain echocardiography for diagnosing chest pain in the emergency room: a multicentre prospective study by the Israeli echo research group
- Source :
- European heart journal. Cardiovascular Imaging. 18(9)
- Publication Year :
- 2016
-
Abstract
- Aims Left ventricular (LV) two-dimensional longitudinal strain (2DLS) analysis by echocardiography has been suggested as a useful tool for the detection of acute coronary syndromes (ACS). Our aim was to determine whether 2DLS analysis could assist in triage of patients with chest pain (CP) in the emergency department (ED). Methods and results We prospectively enrolled patients presenting to the ED with CP and suspected ACS but without a diagnostic ECG or elevated troponin. An echocardiogram was performed within 24 h of CP. For each patient, a histogram of LV myocardial peak systolic strain (PSS) was generated and the value identifying the 20% worst strain values (PSS20%) was determined. A predefined value of greater than −17% was considered abnormal. 2DLS analysis was available for 605 patients (mean age 58 ± 9 years, 70% males), of which 74 (12.2%) had ACS. During a 6-month follow-up, MACE occurred in 4 (5.8%) patients with and in 3 (0.6%) without ACS. An abnormal PSS20% was present in 60/74 patients with ACS (sensitivity 81%, negative predictive value 91%), but also in 391/531 patients without ACS (specificity 26%, positive predictive value 13%). Similar results were found for global longitudinal strain (GLS). Receiver-operating characteristic curves showed an area under curve of 0.59 for PSS20% and 0.6 for GLS ( P = 0.3). Independent predictors of abnormal 2DLS were male gender, body mass index, heart rate, and mean tissue Doppler e ′, but not ACS. Conclusion In this large multicentre prospective study, 2DLS was not a useful tool to rule out ACS in the ED. Clinical trial registration . Unique identifier NCT01163019.
- Subjects :
- Male
medicine.medical_specialty
Acute coronary syndrome
Chest Pain
Speckle tracking echocardiography
030204 cardiovascular system & hematology
Chest pain
Risk Assessment
Severity of Illness Index
Cohort Studies
Diagnosis, Differential
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Odds Ratio
Humans
Radiology, Nuclear Medicine and imaging
030212 general & internal medicine
Prospective Studies
Systole
Acute Coronary Syndrome
Israel
Prospective cohort study
Aged
biology
business.industry
General Medicine
Emergency department
Middle Aged
medicine.disease
Troponin
Surgery
Survival Rate
ROC Curve
Echocardiography
Cardiology
biology.protein
Female
medicine.symptom
Symptom Assessment
Cardiology and Cardiovascular Medicine
business
Emergency Service, Hospital
Mace
Follow-Up Studies
Subjects
Details
- ISSN :
- 20472412 and 01163019
- Volume :
- 18
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- European heart journal. Cardiovascular Imaging
- Accession number :
- edsair.doi.dedup.....6a9347ba6c7eded6a038ddc104b1e703