title: Efficacy of myocardial contrast echocardiography in the diagnosis and risk stratification of acute coronary syndrome.
abstract: We examined the hypothesis that myocardial contrast echocardiography (MCE) is superior to conventional electrocardiographic, echocardiographic, and troponin I criteria for the diagnosis of acute coronary syndrome. We prospectively enrolled 114 consecutive patients (60+/-10 years of age, 73 men) who presented to the emergency room with chest pain on exertion and at rest. Exclusion criteria included an age<40 years, presence of Q wave or ST-segment elevation, and a poor echocardiographic window. Echocardiography and MCE were performed to assess regional wall motion abnormalities (RWMAs) and myocardial perfusion defects by using continuous infusion of perfluorocarbon-exposed sonicated dextrose albumin. Acute coronary syndrome was confirmed in 87 patients. There were no deaths; 46 patients had acute myocardial infarction, and 41 patients required urgent revascularization. On multiple logistic regression analysis, myocardial perfusion defect (odd ratio 87, p<0.001) was the only independent variable for diagnosing acute coronary syndrome. Myocardial perfusion defect (odd ratio 21, p=0.001) and troponin I levels (odd ratio 3, p=0.009) were independent predictors for acute myocardial infarction. The sensitivity of myocardial perfusion defect for diagnosing acute coronary syndrome was 77%, which is significantly higher than the sensitivities of ST change, troponin I increase, and RWMA (28%, 34%, and 49%, respectively), with similar specificities of 85% to 96%. In conclusion, MCE is more sensitive than the currently used electrocardiographic and troponin I criteria, and evaluation of myocardial perfusion defect by MCE complements RWMA analysis by conventional echocardiography for accurate diagnosis of acute coronary syndrome.
authors.affiliation: The Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea. dhkang@amc.seoul.kr
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Kee-Jun
authors.initials: KJ
authors.lastname: Choi
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000208:Acute Disease; D003327:Coronary Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D016017:Odds Ratio; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000008:administration & dosage; D000075462:Serum Albumin, Human; D012720:Severity of Illness Index; D013577:Syndrome; D019210:Troponin I / Q000097:blood
chemical_list: D005466:Fluorocarbons; D012709:Serum Albumin; D019210:Troponin I; C094311:dextrose albumin solution; D005947:Glucose; D000075462:Serum Albumin, Human