Resting echocardiography for the early detection of acute coronary syndromes in chest pain unit patients.
OBJECTIVE
The purpose of this study is to assess the ability of resting echocardiography to detect an acute coronary syndrome (ACS) before the occurrence of ischemic electrocardiogram (ECG) changes or troponin-T elevations.


METHODS
Four hundred and three patients who presented to the emergency room (ER) with chest pain, normal ECGs, and normal troponin-T levels were admitted to the cardiologist-run Chest Pain Unit (CPU) for further monitoring. They underwent serial resting echocardiography for monitoring of left ventricle wall motion (LVWM), ECG telemetry monitoring, and serial troponin-T measurements.


RESULTS
An ACS was detected in 49 patients (12.1%). These 49 patients were then subdivided into three different groups based on the initial mode of detection of their ACS. In group A, 16 of 49 (32.6%) patients had ACS shown by echocardiographic detection of LVWM abnormalities. In group B, 24 of 49 (48.9%) patients had an ACS detected by ischemic ECG changes. In group C, 9 of 49 (18.3%) patients had an ACS detected by troponin-T elevations. The shortest time interval between CPU-admission and ACS-detection occurred in group A (A vs. B, P < 0.003; A vs. C, P < 0.0001). In group A, cardiac angiogram showed that the culprit coronary lesion was more frequent in the circumflex artery (11 out of 16; 68.7%) (LCx vs. LAD, P < 0.02; LCx vs. RCA, P < 0.001) and of these 11 patients with circumflex lesions, the ECG was normal in eight (72.7%) patients.


CONCLUSIONS
This study demonstrates the utility of LVWM monitoring by serial echocardiography as part of a diagnostic protocol that can be implemented in a CPU. Furthermore, echocardiography could become an essential tool used in the diagnosis of ACS secondary to circumflex lesions.
Parato
Vito Maurizio
VM
Chest Pain Unit, Cardiology Department, C. and G. Mazzoni Hospital, Ascoli Piceno, Italy. vm.parato@sanita.marche.it
Mehta
Anjlee
A
Delfino
Domenico
D
Amabili
Stenio
S
Partemi
Manrico
M
Grossi
Pierfrancesco
P
Nardini
Emidio
E
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D042241:Early Diagnosis; D004452:Echocardiography / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012146:Rest; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity