title: The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry.
abstract: OBJECTIVE
  To analyze the current usage of transthoracic echocardiography (TTE) as a rapid, noninvasive tool in the early stratification of acute chest pain in certified German chest pain units (CPUs).
  
  
  METHODS
  A total of 23,997 patients were enrolled. Analyses comprised TTE evaluation rates in relation to clinical presentation, risk profile, left ventricular impairment, final diagnosis and invasive management. Critical times were assessed. Multivariable analyses for independent determinants for the use of TTE were performed.
  
  
  RESULTS
  TTE evaluation was available in CPUs in 70.1% of cases. It was associated with lower rates of invasive management in unstable angina pectoris (UAP) and with higher rates in patients with initially suspected non-cardiac origin of symptoms and/or reduced systolic function (p < 0.05). Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was an independent determinant favoring TTE evaluation [NSTE-myocardial infarction: odds ratio (OR) 1.62; UAP: OR 1.34; p < 0.001 for both]. Clinical signs of heart failure (OR 1.31; p < 0.001), referral by emergency medical service (OR 1.18; p < 0.001) and kidney failure (OR 1.16; p < 0.05) were independently associated with higher TTE rates. TTE did not delay door-to-balloon times.
  
  
  CONCLUSIONS
  About two thirds of the patients admitted to certified CPUs received TTE evaluation, with the highest rates being in ACS patients, and thereby providing diagnostic information supporting or refuting further invasive management.
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Breuckmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Thomas
authors.initials: T
authors.lastname: Voigtländer
authors.forename: Michael
authors.initials: M
authors.lastname: Haude
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.forename: Harald
authors.initials: H
authors.lastname: Mudra
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.forename: Burghard
authors.initials: B
authors.lastname: Schumacher
authors.forename: Sebastian
authors.initials: S
authors.lastname: Barth
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Birgit
authors.initials: B
authors.lastname: Hailer
authors.forename: Dirk
authors.initials: D
authors.lastname: Walther
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors