title: Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department.
abstract: Left ventricular strain echocardiography is reported to be more sensitive in detecting myocardial ischemia than conventional transthoracic echocardiography (TTE). We evaluated the usefulness of 2D strain analysis for the assessment of acute chest pain in emergency department (ED). Patients presenting to ED with acute chest pain were recruited. Patients with ST-elevation myocardial infarction, known coronary artery disease (CAD), non-ischemic cardiomyopathy, or non-cardiac chest pain were excluded. The pretest probability of CAD and TTEs were evaluated in all patients. TTEs included visual assessments of regional wall motion abnormality (RWMA) and analysis of global and regional longitudinal strain (GLS and RLS). The diagnosis of CAD and the occurrence of cardiac events during 1 month after ED visit were reviewed. Cardiac events were observed in 25% of total 104 patients, and CAD was detected in 36% of 69 patients with coronary imaging tests. Compared to RWMA, RLS showed higher sensitivity (sensitivity/specificity = 64/89 vs. 92/77%) with similar diagnostic accuracy (79.7 vs. 82.6%, p = 0.791) for CAD. RLS also demonstrated better diagnostic performance than either GLS (sensitivity/specificity = 92/57%) or pretest probability (sensitivity/specificity = 72/64 %). Similarly, RLS had the higher predictive value for 1-month cardiac events. In multivariable analyses including pretest probability, LVEF, RWMA, cardiac enzyme, GLS, and RLS; only pretest probability (OR 1.91, 95% CI 1.22-2.99, p = 0.005) and RLS (OR 25.42, 95 % CI 1.84-342.04, p = 0.016) independently predicted CAD. Strain echocardiography appears to be effective in diagnosing CAD and predicting future events with high sensitivity and negative predictive value in acute chest pain patients visiting ED.
authors.affiliation: , Seoul, Republic of Korea.
authors.forename: Mirae
authors.initials: M
authors.lastname: Lee
authors.forename: Sung-A
authors.initials: SA
authors.lastname: Chang
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Cho
authors.forename: Sung-Ji
authors.initials: SJ
authors.lastname: Park
authors.forename: Jin-Oh
authors.initials: JO
authors.lastname: Choi
authors.forename: Sang-Chol
authors.initials: SC
authors.lastname: Lee
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Seung Woo
authors.initials: SW
authors.lastname: Park
mesh_terms: D059787:Acute Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D019540:Area Under Curve; D001331:Automation; D016507:Cardiology Service, Hospital; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D003937:Diagnosis, Differential; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D014463:Ultrasonography; D016277:Ventricular Function, Left