Myocardial deformation by strain echocardiography identifies patients with acute coronary syndrome and non-diagnostic ECG presenting in a chest pain unit: a prospective study of diagnostic accuracy

摘要: Clinical assessment often cannot risk stratify patients hospitalized with chest pain and non-diagnostic electrocardiography (ECG) or myocardial enzymes. An inappropriate admission of non-cardiac is an enormous cost factor. 2315 who presented in the unit (CPU) symptoms suggestive acute coronary syndrome (ACS) were screened. All relevant changes ECG enzymes excluded. 268 consecutive (mean 58 ± 7 years, 88 men) prospectively included underwent echocardiography for left ventricular ejection fraction (LVEF), wall motion score index (WMSI) strain parameter a angiography (CA) within 2 ± 1 days after admission. Anatomically obstructive artery disease (CAD) (≥70 % diameter stenosis) was present 110 (41 %). The incremental value LVEF, WMSI, parameters to clinical variables determined nested Cox models. Baseline data associated CAD age [hazard ratio (HR) 1.31, p = 0.03], arterial hypertension (HR 1.39, p = 0.03) diabetes 1.46, p = 0.001). addition endocardial global circumferential (GCS) 1.57, p < 0.001) caused greatest increment model power (χ 2 = 43.4, p < 0.001). Optimal cut-off calculated as -21.7 % GCS (sensitivity 87 %, specificity 76 %) differentiate between these patients. In suspected ACS but without enzyme abnormalities, deformation imaging can identify at risk. This approach may be applied improve decision guidance CPU fast discharge prompt cardiological allocation CAD. NCT 02357641.