title: Stress echocardiography in the ED: diagnostic performance in high-risk subgroups.
abstract: OBJECTIVE
  To assess stress-echo (SE) diagnostic performance in patients presenting to the emergency department (ED) with spontaneous chest pain, especially in subgroups in which exercise ECG diagnostic performance has been questioned (women, elderly, history of coronary artery disease).
  
  
  METHODS
  Between June 2008 and May 2011, 474 patients with an episode of spontaneous chest pain, non-diagnostic electrocardiogram and negative cardiac necrosis markers underwent SE. Patients with inducible ischemia (Isch) were asked to undergo coronary angiography. Patients with negative SE were discharged and contacted by telephone at least 6 months after discharge, to ascertain the occurrence of new cardiac events.
  
  
  RESULTS
  Exercise stress-echo (ESE) was employed in 270 patients and dobutamine (DSE) in 218 (including 14 with inconclusive ESE); a diagnosis of coronary artery disease (CAD) was confirmed or excluded in 434 (92%) patients. SE was negative for Isch in 318 patients (206 ESE and 112 DSE) and positive in 132. During follow-up, patients with negative SE had 4 cardiac events. SE showed: sensitivity 90%, specificity 92%, positive predictive value 78% and negative predictive value 97%. Sensitivity was comparable between patients aged < or ≥70 years (84 vs 94%) and between gender (89 vs 96%), but lower in patients with known CAD (88 vs 94%, P < .05); specificity was comparable regardless of age (94 vs 99%) and presence of CAD (97 vs 91%), but was lower among women (87 vs 96%, P < .05).
  
  
  CONCLUSIONS
  SE had a very good diagnostic performance in ED patients with suspected Isch, both overall and in selected high-risk groups.
authors.affiliation: Department of Critical Care Medicine and Surgery, Intensive Observation Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: innocentif@aou-careggi.toscana.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Innocenti
authors.forename: Delia
authors.initials: D
authors.lastname: Lazzeretti
authors.forename: Alberto
authors.initials: A
authors.lastname: Conti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zanobetti
authors.forename: Sonia
authors.initials: S
authors.lastname: Vicidomini
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pini
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors