Joerg Schroeder1, Sandra Hamada1, Nina Gründlinger2, Tanja Rubeau1, Ertunc Altiok1, Katrin Ulbrich1, Andras Keszei3, Nikolaus Marx1, Michael Becker4. 1. Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany. 2. Department of Internal Medicine, Hospital St. Brigida, Simmerath, Germany. 3. Department of Medical Statistics, RWTH Aachen University, Aachen, Germany. 4. Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany. mibecker@ukaachen.de.
Abstract
OBJECTIVE: Clinical assessment often cannot risk stratify patients hospitalized with chest pain and non-diagnostic electrocardiography (ECG) or myocardial enzymes. An inappropriate admission of patients with non-cardiac chest pain is an enormous cost factor. METHODS: 2315 patients who presented in the chest pain unit (CPU) with symptoms suggestive of acute coronary syndrome (ACS) were screened. All patients with relevant changes in ECG or myocardial enzymes were excluded. 268 consecutive patients (mean 58 ± 7 years, 88 men) were prospectively included and underwent echocardiography for left ventricular ejection fraction (LVEF), wall motion score index (WMSI) and strain parameter and a coronary angiography (CA) within 2 ± 1 days after admission. RESULTS: Anatomically obstructive coronary artery disease (CAD) (≥70 % diameter stenosis) was present in 110 patients (41 %). The incremental value of LVEF, WMSI, and strain parameters to relevant clinical variables was determined in nested Cox models. Baseline clinical data associated with relevant CAD were age [hazard ratio (HR) 1.31, p = 0.03], arterial hypertension (HR 1.39, p = 0.03) and diabetes (HR 1.46, p = 0.001). The addition of endocardial global circumferential strain (GCS) (HR 1.57, p < 0.001) caused the greatest increment in model power (χ (2) = 43.4, p < 0.001). Optimal cut-off value was calculated as -21.7 % for GCS (sensitivity 87 %, specificity 76 %) to differentiate between these patients. CONCLUSIONS: In patients with suspected ACS but without ECG changes or myocardial enzyme abnormalities, myocardial deformation imaging can identify patients at risk. This approach may be applied to improve decision guidance at the CPU for fast discharge of patients with non-cardiac chest pain or prompt cardiological allocation of patients with CAD. CLINICAL TRIAL REGISTRATION: NCT 02357641.
OBJECTIVE: Clinical assessment often cannot risk stratify patients hospitalized with chest pain and non-diagnostic electrocardiography (ECG) or myocardial enzymes. An inappropriate admission of patients with non-cardiac chest pain is an enormous cost factor. METHODS: 2315 patients who presented in the chest pain unit (CPU) with symptoms suggestive of acute coronary syndrome (ACS) were screened. All patients with relevant changes in ECG or myocardial enzymes were excluded. 268 consecutive patients (mean 58 ± 7 years, 88 men) were prospectively included and underwent echocardiography for left ventricular ejection fraction (LVEF), wall motion score index (WMSI) and strain parameter and a coronary angiography (CA) within 2 ± 1 days after admission. RESULTS: Anatomically obstructive coronary artery disease (CAD) (≥70 % diameter stenosis) was present in 110 patients (41 %). The incremental value of LVEF, WMSI, and strain parameters to relevant clinical variables was determined in nested Cox models. Baseline clinical data associated with relevant CAD were age [hazard ratio (HR) 1.31, p = 0.03], arterial hypertension (HR 1.39, p = 0.03) and diabetes (HR 1.46, p = 0.001). The addition of endocardial global circumferential strain (GCS) (HR 1.57, p < 0.001) caused the greatest increment in model power (χ (2) = 43.4, p < 0.001). Optimal cut-off value was calculated as -21.7 % for GCS (sensitivity 87 %, specificity 76 %) to differentiate between these patients. CONCLUSIONS: In patients with suspected ACS but without ECG changes or myocardial enzyme abnormalities, myocardial deformation imaging can identify patients at risk. This approach may be applied to improve decision guidance at the CPU for fast discharge of patients with non-cardiac chest pain or prompt cardiological allocation of patients with CAD. CLINICAL TRIAL REGISTRATION: NCT 02357641.
Authors: Piotr Lipiec; Paulina Wejner-Mik; Maria Krzemińska-Pakuła; Jacek Kuśmierek; Anna Płachcińska; Remigiusz Szumiński; Jan Z Peruga; Jarosław D Kasprzak Journal: J Am Soc Echocardiogr Date: 2008-04-02 Impact factor: 5.251
Authors: Harold I Litt; Constantine Gatsonis; Brad Snyder; Harjit Singh; Chadwick D Miller; Daniel W Entrikin; James M Leaming; Laurence J Gavin; Charissa B Pacella; Judd E Hollander Journal: N Engl J Med Date: 2012-03-26 Impact factor: 91.245
Authors: Marit Kristine Smedsrud; Sebastian Sarvari; Kristina H Haugaa; Ola Gjesdal; Stein Ørn; Lars Aaberge; Otto A Smiseth; Thor Edvardsen Journal: J Am Coll Cardiol Date: 2012-08-29 Impact factor: 24.094
Authors: John F Heitner; Igor Klem; Derek Rasheed; Abhinav Chandra; Han W Kim; Lowie M R Van Assche; Michele Parker; Robert M Judd; James G Jollis; Raymond J Kim Journal: Radiology Date: 2013-12-10 Impact factor: 11.105
Authors: Gaetano Nucifora; Joanne D Schuijf; Victoria Delgado; Matteo Bertini; Arthur J H A Scholte; Arnold C T Ng; Jacob M van Werkhoven; J Wouter Jukema; Eduard R Holman; Ernst E van der Wall; Jeroen J Bax Journal: Am Heart J Date: 2010-01 Impact factor: 4.749
Authors: C Eick; M Duckheim; P Groga-Bada; N Klumpp; S Mannes; C S Zuern; M Gawaz; K D Rizas; Axel Bauer Journal: Clin Res Cardiol Date: 2017-03-22 Impact factor: 5.460
Authors: Maria Vincenza Polito; Stephan Stoebe; Leonard Leifels; Patrick Stumpp; Kilian Solty; Gennaro Galasso; Federico Piscione; Ulrich Laufs; Karin Klingel; Andreas Hagendorff Journal: Clin Res Cardiol Date: 2018-05-18 Impact factor: 5.460
Authors: Wouter M van Everdingen; Alexander H Maass; Kevin Vernooy; Mathias Meine; Cornelis P Allaart; Frederik J De Lange; Arco J Teske; Bastiaan Geelhoed; Michiel Rienstra; Isabelle C Van Gelder; Marc A Vos; Maarten J Cramer Journal: Cardiovasc Ultrasound Date: 2017-10-18 Impact factor: 2.062
Authors: Maria Concetta Pastore; Giulia Elena Mandoli; Francesco Contorni; Luna Cavigli; Marta Focardi; Flavio D'Ascenzi; Giuseppe Patti; Sergio Mondillo; Matteo Cameli Journal: Biomed Res Int Date: 2021-02-02 Impact factor: 3.411