title: Two-dimensional strain echocardiography for diagnosing chest pain in the emergency room: a multicentre prospective study by the Israeli echo research group.
abstract: OBJECTIVE
  Left ventricular (LV) two-dimensional longitudinal strain (2DLS) analysis by echocardiography has been suggested as a useful tool for the detection of acute coronary syndromes (ACS). Our aim was to determine whether 2DLS analysis could assist in triage of patients with chest pain (CP) in the emergency department (ED).
  
  
  RESULTS
  We prospectively enrolled patients presenting to the ED with CP and suspected ACS but without a diagnostic ECG or elevated troponin. An echocardiogram was performed within 24 h of CP. For each patient, a histogram of LV myocardial peak systolic strain (PSS) was generated and the value identifying the 20% worst strain values (PSS20%) was determined. A predefined value of greater than -17% was considered abnormal. 2DLS analysis was available for 605 patients (mean age 58 ± 9 years, 70% males), of which 74 (12.2%) had ACS. During a 6-month follow-up, MACE occurred in 4 (5.8%) patients with and in 3 (0.6%) without ACS. An abnormal PSS20% was present in 60/74 patients with ACS (sensitivity 81%, negative predictive value 91%), but also in 391/531 patients without ACS (specificity 26%, positive predictive value 13%). Similar results were found for global longitudinal strain (GLS). Receiver-operating characteristic curves showed an area under curve of 0.59 for PSS20% and 0.6 for GLS (P= 0.3). Independent predictors of abnormal 2DLS were male gender, body mass index, heart rate, and mean tissue Doppler e', but not ACS.
  
  
  CONCLUSIONS
  In this large multicentre prospective study, 2DLS was not a useful tool to rule out ACS in the ED.
  
  
  BACKGROUND
  http://clinicaltrials.gov.
  NCT01163019.
authors: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: Avinoam
authors: A
authors: Shiran
authors: Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.|Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.
authors: David S
authors: DS
authors: Blondheim
authors: Kaplan Medical Center, Rehovot, Israel.|Hebrew University, Jerusalem, Israel.
authors: Sara
authors: S
authors: Shimoni
authors: Department of Cardiology, Haemek Medical Center, Afula, Israel.
authors: Mohamed
authors: M
authors: Jabarren
authors: Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors: David
authors: D
authors: Rosenmann
authors: Department of Cardiology, Rabin medical Center, Petah Tikva, Israel.
authors: Alex
authors: A
authors: Sagie
authors: Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors: David
authors: D
authors: Leibowitz
authors: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors: Marina
authors: M
authors: Leitman
authors: Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Micha
authors: M
authors: Feinberg
authors: Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors: Ronen
authors: R
authors: Beeri
authors: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: Salim
authors: S
authors: Adawi
authors: Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.|Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.
authors: Avraham
authors: A
authors: Shotan
authors: Kaplan Medical Center, Rehovot, Israel.|Hebrew University, Jerusalem, Israel.
authors: Sorel
authors: S
authors: Goland
authors: Department of Cardiology, Haemek Medical Center, Afula, Israel.
authors: Lev
authors: L
authors: Bloch
authors: Devision of Cardiology, Soroka University Medical Center, Beer Sheva, Israel.|Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Sergio L
authors: SL
authors: Kobal
authors: Devision of Cardiology, Soroka University Medical Center, Beer Sheva, Israel.|Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Noah
authors: N
authors: Liel-Cohen
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D063189:Symptom Assessment / Q000379:methods*
keywords: acute coronary syndrome; chest pain; emergency department; longitudinal strain; speckle tracking echocardiography