title: Exercise echocardiography and multidetector computed tomography for the evaluation of acute chest pain.
abstract: OBJECTIVE
  Up to 4% of patients with acute chest pain, normal electrocardiogram, and negative troponins present major adverse cardiac events as a result of undiagnosed acute coronary syndrome. Our aim was to compare the diagnostic performance of multidetector computed tomography and exercise echocardiography in patients with a low-to-intermediate probability of coronary artery disease.
  
  
  METHODS
  We prospectively included 69 patients with acute chest pain, normal electrocardiogram, and negative troponins who underwent coronary tomography angiography and exercise echocardiography. Patients with coronary stenosis ≥ 50% or Agatston calcium score ≥ 400 on coronary tomography angiography or positive exercise echocardiography, or with inconclusive results, were admitted to rule out acute coronary syndrome.
  
  
  RESULTS
  An acute coronary syndrome was confirmed in 17 patients (24.6%). This was lower than the suspected 42% based on coronary tomography angiography (P<.05) and not significantly different than the suspected 29% based on the results of exercise echocardiography (P=.56). Exercise echocardiography was normal in up to 37% of patients with pathological findings on coronary tomography angiography. The latter technique provided a higher sensitivity (100% vs 82.3%; P=.21) but lower specificity (76.9% vs 88.4%; P=.12) than exercise echocardiography for the diagnosis of acute coronary syndrome, although without reaching statistical significance. Increasing the stenosis cutoff point to 70% increased the specificity of coronary tomography angiography to 88.4%, while maintaining high sensitivity.
  
  
  CONCLUSIONS
  Coronary tomography angiography offers a valid alternative to exercise echocardiography for the diagnosis of acute coronary syndrome among patients with low-to-intermediate probability of coronary artery disease. A combination of both techniques could improve the diagnosis of acute coronary syndrome.
authors.affiliation: Servicio de Cardiología, Instituto Clínico del Tórax, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Mas-Stachurska
authors.affiliation: Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain; Grupo de investigación "Urgencias: procesos y patologías", Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Miró
authors.affiliation: Servicio de Cardiología, Instituto Clínico del Tórax, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.affiliation: Centro de Diagnóstico por la Imagen, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: de Caralt
authors.affiliation: Centro de Diagnóstico por la Imagen, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Rosario J
authors.initials: RJ
authors.lastname: Perea
authors.affiliation: Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: López
authors.affiliation: Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain; Grupo de investigación "Urgencias: procesos y patologías", Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Sánchez
authors.affiliation: Servicio de Cardiología, Instituto Clínico del Tórax, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Paré
authors.affiliation: Servicio de Cardiología, Instituto Clínico del Tórax, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.affiliation: Servicio de Cardiología, Instituto Clínico del Tórax, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain. Electronic address: jtortiz@clinic.ub.es.
authors.forename: José T
authors.initials: JT
authors.lastname: Ortiz-Pérez
mesh_terms: D059787:Acute Pain / Q000175:diagnosis* / Q000209:etiology; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results
keywords: Angina inestable; Diagnosis; Diagnóstico; Ecocardiografía de ejercicio; Exercise echocardiography; Multidetector computed tomography; Tomografía computarizada multidetectores; Unstable angina