European Heart Journal Advance Access originally published online on May 25, 2005
European Heart Journal 2005 26(16):1606-1611; doi:10.1093/eurheartj/ehi335
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Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation
1The Cardiovascular Imaging Center, Cardiovascular Division, University of Virginia, Box 800158, Medical Center, Charlottesville, VA 22908-0158, USA
2The Division of Biostatistics and Epidemiology, Department of Health Evaluation Sciences, University of Virginia, Charlottesville, VA, USA
Received 8 February 2005; revised 24 April 2005; accepted 28 April 2005; online publish-ahead-of-print 25 May 2005.
* Corresponding author. Tel: +1 434 924 5928; fax: +1 434 982 3183. E-mail address: sk{at}virginia.edu
See page 1573 for the editorial comment on this article (doi:10.1093/eurheartj/ehi381)
Aims We hypothesized that the assessment of left ventricular regional function (RF) and myocardial perfusion (MP) will provide incremental value over routine evaluation in patients who present to the emergency department (ED) with chest pain (CP) and no ST-segment elevation.
Methods and results In addition to routine clinical evaluation, patients with suspected cardiac CP and no ST-segment elevation were evaluated in the ED for RF and MP using contrast echocardiography (CE). Cardiac-related death, acute myocardial infarction, unstable angina pectoris, congestive heart failure (CHF), and revascularization were considered as events within 48 h (early). Of the 1017 patients studied, 166 (16.3%) had early events. Adding RF increased the prognostic information of clinical and EKG variables significantly (Bonferroni corrected P<0.0001) for predicting these events. When MP was added, significant additional prognostic information was obtained (Bonferroni corrected P=0.0002). All patients were followed for a median of 7.7 months (25th–75th percentiles: 2.7–12.5) Of these, 292 (28.7%) had events. Adding RF increased the prognostic information of clinical and EKG variables for determining the risk of events significantly (Bonferroni corrected P<0.0001), which was further increased by adding MP (Bonferroni corrected P<0.0001).
Conclusion Early assessment of RF on CE adds significant diagnostic and prognostic value to routine evaluation in patients presenting to the ED with suspected cardiac CP and no ST-segment elevation. MP provides additional significant value. CE could be a valuable tool in the early triage and management of CP patients presenting to the ED.
Key Words: Myocardial ischaemia • Emergency department • Myocardial contrast echocardiography
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