Rinkevich Diana, Kaul Sanjiv, Wang Xin-Qun, Tong Khim Leng, Belcik Todd, Kalvaitis Saul, Lepper Wolfgang, Dent John M, Wei Kevin
The Cardiovascular Imaging Center, Cardiovascular Division, University of Virginia, Medical Center, Charlottesville, VA 22908-0158, USA.
Eur Heart J. 2005 Aug;26(16):1606-11. doi: 10.1093/eurheartj/ehi335. Epub 2005 May 25.
We hypothesized that the assessment of left ventricular regional function (RF) and myocardial perfusion (MP) will provide incremental value over routine evaluation in patients who present to the emergency department (ED) with chest pain (CP) and no ST-segment elevation.
In addition to routine clinical evaluation, patients with suspected cardiac CP and no ST-segment elevation were evaluated in the ED for RF and MP using contrast echocardiography (CE). Cardiac-related death, acute myocardial infarction, unstable angina pectoris, congestive heart failure (CHF), and revascularization were considered as events within 48 h (early). Of the 1017 patients studied, 166 (16.3%) had early events. Adding RF increased the prognostic information of clinical and EKG variables significantly (Bonferroni corrected P<0.0001) for predicting these events. When MP was added, significant additional prognostic information was obtained (Bonferroni corrected P=0.0002). All patients were followed for a median of 7.7 months (25th-75th percentiles: 2.7-12.5) Of these, 292 (28.7%) had events. Adding RF increased the prognostic information of clinical and EKG variables for determining the risk of events significantly (Bonferroni corrected P<0.0001), which was further increased by adding MP (Bonferroni corrected P<0.0001).
Early assessment of RF on CE adds significant diagnostic and prognostic value to routine evaluation in patients presenting to the ED with suspected cardiac CP and no ST-segment elevation. MP provides additional significant value. CE could be a valuable tool in the early triage and management of CP patients presenting to the ED.
我们推测，对于因胸痛（CP）且无ST段抬高而就诊于急诊科（ED）的患者，评估左心室局部功能（RF）和心肌灌注（MP）相较于常规评估将具有额外价值。
除常规临床评估外，在急诊科对疑似心脏性CP且无ST段抬高的患者使用对比超声心动图（CE）评估RF和MP。将心脏相关死亡、急性心肌梗死、不稳定型心绞痛、充血性心力衰竭（CHF）和血运重建视为48小时内（早期）的事件。在研究的1017例患者中，166例（16.3%）发生早期事件。添加RF显著增加了临床和心电图变量预测这些事件的预后信息（Bonferroni校正P<0.0001）。添加MP后，获得了显著的额外预后信息（Bonferroni校正P=0.0002）。所有患者的中位随访时间为7.7个月（第25至75百分位数：2.7 - 12.5）。其中，292例（28.7%）发生事件。添加RF显著增加了临床和心电图变量确定事件风险的预后信息（Bonferroni校正P<0.0001），添加MP后进一步增加（Bonferroni校正P<0.0001）。
在急诊科对疑似心脏性CP且无ST段抬高的患者进行CE早期评估RF，可为常规评估增加显著的诊断和预后价值。MP提供额外的显著价值。CE可能是对就诊于急诊科的CP患者进行早期分诊和管理的有价值工具。
