title: Clinical usefulness of myocardial contrast echocardiography to detect stress-induced cardiomyopathy in the emergency department.
abstract: BACKGROUND
  The purpose of this study was to investigate the clinical usefulness of myocardial contrast echocardiography (MCE) to distinguish stress-induced cardiomyopathy (SCMP) from acute myocardial infarction (AMI) in the emergency department (ED).
  
  
  RESULTS
  We investigated 51 patients (62±13 years, 29 women) who had suspected SCMP in the ED with acute chest pain and showed apical wall motion abnormality on 2-dimensional echocardiography. All patients were assessed by real-time MCE and the perfusion status and quantitative myocardial perfusion parameters were analyzed. After MCE, coronary angiography was performed within 24h. Of 51 patients, 27 had significant perfusion defects (group A) and 24 had preserved perfusion at the apex (group B) by MCE. In group A, 25 patients showed significant luminal stenosis in the left anterior descending artery (LAD) and 2 patients showed no critical luminal stenosis. In group B, 20 patients showed no luminal stenosis and 4 patients showed moderate LAD stenosis. Sensitivity, specificity, positive and negative predictive values of MCE for detection of SCMP were 91%, 86.2%, 83%, and 93%, respectively. Quantitative MCE parameters were significantly decreased in group A compared with group B.
  
  
  CONCLUSIONS
  Myocardial perfusion measured by MCE is relatively preserved in patients with SCMP compared with those with AMI. Therefore, real-time MCE may be a useful noninvasive diagnostic tool to distinguish SCMP from AMI in the ED.
authors.affiliation: Division of Cardiology, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Jong-Ho
authors.initials: JH
authors.lastname: Nam
authors.forename: Jang-Won
authors.initials: JW
authors.lastname: Son
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Lee
authors.forename: Ung
authors.initials: U
authors.lastname: Kim
authors.forename: Jong-Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Dong-Gu
authors.initials: DG
authors.lastname: Shin
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D004636:Emergency Service, Hospital; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D013312:Stress, Physiological; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren