Use of Echocardiography in the Evaluation of Chest Pain in the Emergency Department
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Angina |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | June 2005 |
Chest pain is one of the most common complaints that brings a patient to the emergency
department (ED). The differential diagnosis of chest pain is broad and includes cardiac as
well as non-cardiac diseases. One of the initial goals in the ED evaluation of a patient
presenting with chest pain is to rapidly and accurately diagnose the presence or absence of
acute coronary syndrome. The diagnostic accuracy of the initial routine evaluation is often
limited and results in frequent admissions for patients presenting with chest pain for
further diagnostic testing.
Echocardiography has a high sensitivity and specificity for the diagnosis of acute
myocardial infarction. Tissue Doppler imaging with strain and strain rate (SR) measurement
is a new echocardiographic technique, which enables accurate assessment of regional left
ventricular systolic and diastolic function. Prior studies have shown that abnormal strain
and SR are highly sensitive markers of ischemia. Acute ischemia induces early systolic
thinning and a delay in the onset of systolic thickening, a progressive decrease in the rate
and degree of maximal systolic thickening, and an abnormal ischemia-related thickening which
occurs after aortic valve closure. A major obstacle to the routine use of echocardiography
in the ED is the need for portable studies, using heavy, bulky portable echo machines. There
are currently available portable hand-held echo machines (GE-Vivid I) that produce high
quality images and offer an opportunity to incorporate echocardiography into routine
practice in the ED.
We propose to study the use of early, portable echocardiography, with detailed assessment of
wall motion and left ventricular function by strain and strain rate measurements, for the
evaluation of chest pain in the ED. We hypothesize that an early with detailed left
ventricular function assessment will be highly sensitive and specific for the diagnosis of
myocardial ischemia, and will enable rapid triage of patients who present to the ED with
chest pain.
department (ED). The differential diagnosis of chest pain is broad and includes cardiac as
well as non-cardiac diseases. One of the initial goals in the ED evaluation of a patient
presenting with chest pain is to rapidly and accurately diagnose the presence or absence of
acute coronary syndrome. The diagnostic accuracy of the initial routine evaluation is often
limited and results in frequent admissions for patients presenting with chest pain for
further diagnostic testing.
Echocardiography has a high sensitivity and specificity for the diagnosis of acute
myocardial infarction. Tissue Doppler imaging with strain and strain rate (SR) measurement
is a new echocardiographic technique, which enables accurate assessment of regional left
ventricular systolic and diastolic function. Prior studies have shown that abnormal strain
and SR are highly sensitive markers of ischemia. Acute ischemia induces early systolic
thinning and a delay in the onset of systolic thickening, a progressive decrease in the rate
and degree of maximal systolic thickening, and an abnormal ischemia-related thickening which
occurs after aortic valve closure. A major obstacle to the routine use of echocardiography
in the ED is the need for portable studies, using heavy, bulky portable echo machines. There
are currently available portable hand-held echo machines (GE-Vivid I) that produce high
quality images and offer an opportunity to incorporate echocardiography into routine
practice in the ED.
We propose to study the use of early, portable echocardiography, with detailed assessment of
wall motion and left ventricular function by strain and strain rate measurements, for the
evaluation of chest pain in the ED. We hypothesize that an early with detailed left
ventricular function assessment will be highly sensitive and specific for the diagnosis of
myocardial ischemia, and will enable rapid triage of patients who present to the ED with
chest pain.
Inclusion Criteria:
1. Age 18 or older
2. Chief complaint on presentation to ED: chest pain
3. Differential diagnosis includes acute coronary syndrome as determined by the
Emergency physician or admitting attending.
4. Admission to the hospital required for further cardiac work up.
Exclusion Criteria:
1. Obvious noncardiac cause of the chest pain
2. Patient requires urgent intervention before echo can be obtained
3. Failure to obtain informed consent
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