Efficacy of myocardial contrast echocardiography in the diagnosis and risk stratification of acute coronary syndrome

Duk Hyun Kang, Soo Jin Kang, Jong Min Song, Kee Jun Choi, Myeong Ki Hong, Jae Kwan Song, Seong Wook Park, Seung Jung Park

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Abstract

We examined the hypothesis that myocardial contrast echocardiography (MCE) is superior to conventional electrocardiographic, echocardiographic, and troponin I criteria for the diagnosis of acute coronary syndrome. We prospectively enrolled 114 consecutive patients (60 ± 10 years of age, 73 men) who presented to the emergency room with chest pain on exertion and at rest. Exclusion criteria included an age <40 years, presence of Q wave or ST-segment elevation, and a poor echocardiographic window. Echocardiography and MCE were performed to assess regional wall motion abnormalities (RWMAs) and myocardial perfusion defects by using continuous infusion of perfluorocarbon-exposed sonicated dextrose albumin. Acute coronary syndrome was confirmed in 87 patients. There were no deaths; 46 patients had acute myocardial infarction, and 41 patients required urgent revascularization. On multiple logistic regression analysis, myocardial perfusion defect (odd ratio 87, p <0.001) was the only independent variable for diagnosing acute coronary syndrome. Myocardial perfusion defect (odd ratio 21, p = 0.001) and troponin I levels (odd ratio 3, p = 0.009) were independent predictors for acute myocardial infarction. The sensitivity of myocardial perfusion defect for diagnosing acute coronary syndrome was 77%, which is significantly higher than the sensitivities of ST change, troponin I increase, and RWMA (28%, 34%, and 49%, respectively), with similar specificities of 85% to 96%. In conclusion, MCE is more sensitive than the currently used electrocardiographic and troponin I criteria, and evaluation of myocardial perfusion defect by MCE complements RWMA analysis by conventional echocardiography for accurate diagnosis of acute coronary syndrome.

Original languageEnglish
Pages (from-to)1498-1502
Number of pages5
JournalAmerican Journal of Cardiology
Volume96
Issue number11
DOIs
Publication statusPublished - 2005 Dec 1

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Acute Coronary Syndrome
Echocardiography
Troponin I
Perfusion
Odds Ratio
Myocardial Infarction
Fluorocarbons
Chest Pain
Hospital Emergency Service
Albumins
Logistic Models
Regression Analysis
Glucose

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kang, Duk Hyun ; Kang, Soo Jin ; Song, Jong Min ; Choi, Kee Jun ; Hong, Myeong Ki ; Song, Jae Kwan ; Park, Seong Wook ; Park, Seung Jung. / Efficacy of myocardial contrast echocardiography in the diagnosis and risk stratification of acute coronary syndrome. In: American Journal of Cardiology. 2005 ; Vol. 96, No. 11. pp. 1498-1502.
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Efficacy of myocardial contrast echocardiography in the diagnosis and risk stratification of acute coronary syndrome. / Kang, Duk Hyun; Kang, Soo Jin; Song, Jong Min; Choi, Kee Jun; Hong, Myeong Ki; Song, Jae Kwan; Park, Seong Wook; Park, Seung Jung.

In: American Journal of Cardiology, Vol. 96, No. 11, 01.12.2005, p. 1498-1502.

Research output: Contribution to journalArticle

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N2 - We examined the hypothesis that myocardial contrast echocardiography (MCE) is superior to conventional electrocardiographic, echocardiographic, and troponin I criteria for the diagnosis of acute coronary syndrome. We prospectively enrolled 114 consecutive patients (60 ± 10 years of age, 73 men) who presented to the emergency room with chest pain on exertion and at rest. Exclusion criteria included an age <40 years, presence of Q wave or ST-segment elevation, and a poor echocardiographic window. Echocardiography and MCE were performed to assess regional wall motion abnormalities (RWMAs) and myocardial perfusion defects by using continuous infusion of perfluorocarbon-exposed sonicated dextrose albumin. Acute coronary syndrome was confirmed in 87 patients. There were no deaths; 46 patients had acute myocardial infarction, and 41 patients required urgent revascularization. On multiple logistic regression analysis, myocardial perfusion defect (odd ratio 87, p <0.001) was the only independent variable for diagnosing acute coronary syndrome. Myocardial perfusion defect (odd ratio 21, p = 0.001) and troponin I levels (odd ratio 3, p = 0.009) were independent predictors for acute myocardial infarction. The sensitivity of myocardial perfusion defect for diagnosing acute coronary syndrome was 77%, which is significantly higher than the sensitivities of ST change, troponin I increase, and RWMA (28%, 34%, and 49%, respectively), with similar specificities of 85% to 96%. In conclusion, MCE is more sensitive than the currently used electrocardiographic and troponin I criteria, and evaluation of myocardial perfusion defect by MCE complements RWMA analysis by conventional echocardiography for accurate diagnosis of acute coronary syndrome.

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