Journal of the American Society of Echocardiography
Volume 23, Issue 6 , Pages 636-642 , June 2010

A Predictive Instrument Using Contrast Echocardiography in Patients Presenting to the Emergency Department with Chest Pain and without ST-Segment Elevation

  • Kevin Wei, MD, FACC

      Affiliations

    • Division of Cardiovascular Medicine and Biostatistics, Oregon Health and Science University, Portland, Oregon
    • ,
  • Dawn Peters, PhD

      Affiliations

    • Division of Cardiovascular Medicine and Biostatistics, Oregon Health and Science University, Portland, Oregon
    • ,
  • Todd Belcik, BS, RDCS

      Affiliations

    • Division of Cardiovascular Medicine and Biostatistics, Oregon Health and Science University, Portland, Oregon
    • ,
  • Saul Kalvaitis, MD

      Affiliations

    • Division of Cardiovascular Medicine and Biostatistics, University of Utah, Salt Lake City, Utah
    • ,
  • Lisa Womak, BS

      Affiliations

    • Division of Cardiovascular Medicine and Biostatistics, University of Virginia, Charlottesville, Virginia
    • ,
  • Diana Rinkevich, MD, FACC

      Affiliations

    • Division of Cardiovascular Medicine and Biostatistics, Oregon Health and Science University, Portland, Oregon
    • ,
  • Khim-Leng Tong, MD, FACC

      Affiliations

    • Division of Cardiovascular Medicine and Biostatistics, University of Singapore, Singapore
    • ,
  • Kenneth Horton, RCS, RDCS

      Affiliations

    • Intermountain Medical Center, Murray, Utah
    • ,
  • Sanjiv Kaul, MD, FASE

      Affiliations

    • Division of Cardiovascular Medicine and Biostatistics, Oregon Health and Science University, Portland, Oregon
    • Corresponding Author InformationReprint requests: Sanjiv Kaul, MD, FASE, Cardiovascular Division, UHN 62, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.

References 

  1. Pope JH, Aufderheide TP, Ruthazer R, Wolard RH, Feldman JA, Beshansky JR, et al. Missed diagnosis of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163–1170
  2. McCarthy BD, Beshansky JR, D'Agostino RB, Selker HP. Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med. 1993;22:579–582
  3. Forest RS, Shofer FS, Sease KL, Hollander JE. Assessment of the standardized reporting guidelines ECG classification system: the presenting ECG predicts 30 day outcomes. Ann Emerg Med. 2004;44:206–221
  4. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Writing committee to Revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1–e157
  5. Kontos MC, Arrowood JA, Paulsen WH, Nixon JV. Early echocardiography can predict cardiac events in emergency department patients with chest pain. Ann Emerg Med. 1998;31:550–557
  6. Sabia P, Abbott RD, Afrookteh A, Keller MW, Touchstone DA, Kaul S. Importance of two-dimensional echocardiographic assessment of left ventricular systolic function in patients presenting to the emergency room with cardiac-related symptoms. Circulation. 1991;84:1615–1624
  7. Kontos MC, Kurdziel K, McQueen R, Arrowood JA, Jesse RL, Ornato JP, et al. Comparison of 2-dimensional echocardiography and myocardial perfusion imaging for diagnosing myocardial infarction in emergency department patients. Am Heart J. 2002;143:659–667
  8. Rinkevich D, Kaul S, Wang XQ, Tong KL, Belcik T, Kalvaitis S, et al. Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation. Eur Heart J. 2005;26:1606–1611
  9. Tong KL, Kaul S, Wang XQ, Rinkevich D, Kalvaitis S, Belcik T, et al. Myocardial contrast echocardiography versus thrombolysis in myocardial infarction score in patients presenting to the emergency department with chest pain and a nondiagnostic electrocardiogram. J Am Coll Cardiol. 2005;46:920–927
  10. Dawson D, Rinkevich D, Belcik T, Jayaweera AR, Rafter P, Kaul S, et al. Measurement of myocardial blood flow velocity reserve with myocardial contrast echocardiography in patients with suspected coronary artery disease: comparison with quantitative gated 99mTc sestamibi SPECT. J Am Soc Echocardiogr. 2003;16:1171–1177
  11. Harrell FE, Lee KL, Mark DB. Tutorial in biostatistics multivariate prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–383
  12. Efron B. Estimating the error rate of a prediction rule: improvement on cross-validation. Improvement on cross-validation. J Am Stat Assoc. 1983;78:316–331
  13. Selker HP, Beshansky JR, Griffith JL, Aufderheide TP, Ballin DS, Bernard SA, et al. Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicenter, controlled clinical trial. Ann Int Med. 1998;129:845–855
  14. Selker HP, Zalenski RJ. An evaluation of technologies for detecting acute cardiac ischemia in the emergency department: a report of the NIH national heart attack alert program. Ann Emerg Med. 1997;29:1–87
  15. Strussman BJ. National Hospital Ambulatory Medicine Care Survey: 1995 Emergency Department Summary. Advance data from vital and health statistics of the Center for Disease Control Prevention/National Center for Health Statistics. 1997;285:1–18.
  16. Gilber WB, Lewis LM, Erb RE, Markens PK, Kaplan BC, Vaughn RH, et al. Early detection of acute myocardial infarction in patients presenting with chest pain and non-diagnostic ECGs: serial CK-MB sampling in the emergency department. Ann Emerg Med. 1990;9:1359–1366
  17. Gilber WB, Young CP, Hedges JR, Lewis LM, Smith MS, Carleton SC, et al. Acute myocardial infarction in chest pain patients with non-diagnostic ECG's: serial CK-MB sampling in the emergency department. Ann Emerg Med. 1992;21:504–512
  18. Cohen M, Hawkins L, Greenberg S, Fuster V. Usefulness of ST-segment changes in greater than or equal to 2 leads on the emergency room electrocardiogram in either unstable anginal pectoris or non-Q-wave myocardial infarction in predicting outcome. Am J Cardiol 19991;67:1368–1373.
  19. Nyman I, Areskog M, Areskog NH, Swahn E, Wallentin L. Very early risk stratification by electrocardiogram at rest in men with suspected unstable coronary heart disease. J Intern Med. 1993;234:293–301
  20. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335:1342–1349
  21. Luscher MS, Thygesen K, Ravkilde J, Heickendorff L for the TRIM Study Group. Applicability of cardiac troponin T and I for early risk stratification in unstable coronary artery disease. Circulation. 1997;96:2578–2585
  22. Kontos MC, Jesse RL, Anderson FP, Schmidt KL, Ornato JP, Tatum JL. Comparison of myocardial perfusion imaging and cardiac troponin I in patients admitted to the emergency department with chest pain. Circulation. 1999;99:2073–2078
  23. Conti A, Gallini C, Costanzo E, Ferri P, Matteini M, Paladini B, et al. Early detection of myocardial ischaemia in the emergency department by rest or exercise 99mTc tracer myocardial SPET in patients with chest pain and non-diagnostic ECG. Eur J Nucl Med. 2001;28:1806–1810
  24. Udelson JE, Beshansky JR, Ballin DS, Feldman JA, Griffith JL, Handler J, et al. Myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia: a randomized controlled trial. JAMA. 2002;288:2693–2700
  25. Antman E, Cohen M, Bernink PJL, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non-ST elevation MI. A method for prognostication and therapeutic decision making. JAMA. 2000;284:835–842
  26. Kalvaitis S, Kaul S, Rinkevich D, Tong KL, Belcik T, Wei K. Effect of time delay on the diagnostic and prognostic utility of myocardial contrast echocardiography in patients presenting with suspected cardiac chest pain to the emergency department. J Am Soc Echocardiogr. 2006;19:1488–1493
  27. Wyrick JJ, Kalvitis S, McConnell J, Rinkevich D, Kaul S, Wei K. Myocardial contrast echocardiography is cost-efficient in patients presenting to the emergency department with suspected cardiac chest pain and a non-diagnostic electrocardiogram. Am J Cardiol. 2008;102:649–652
  28. Hundley WG, Kizilbash AM, Afridi I, Franco F, Peshock RM, Grayburn PA. Effect of contrast enhancement on transthoracic echocardiographic assessment of left ventricular regional wall motion. Am J Cardiol. 1999;84:1365–1368
  29. Malhotra V, Nwogu J, Bondmass MD, Bean M, Bieniarz T, Tertell M, et al. Is the technically limited echocardiographic study an endangered species? Endocardial border delineation with native tissue harmonic imaging and Optison contrast: a review of 200 cases. J Am Soc Echocardiogr. 2000;13:771–773
  30. Thomson HL, Basmadjian AJ, Rainbird AJ, Razavi M, Avierinos JF, Pellikka PA, et al. Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements: a prospective, randomly assigned, blinded study. J Am Coll Cardiol. 2001;38:867–875

 Supported in part by grants to Dr Kaul from the National Institutes of Health (Bethesda, MD) (R01-HL-65704 and R01 EB-002069) and the American Society of Echocardiography (Raleigh, NC). The ultrasound contrast agents were provided by GE Healthcare (Milwaukee, WI) and Lantheus Imaging (North Billerica, MA).

PII: S0894-7317(10)00260-9

doi: 10.1016/j.echo.2010.03.013

Journal of the American Society of Echocardiography
Volume 23, Issue 6 , Pages 636-642 , June 2010

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