Pettemerides Victoria, Turner Thomas, Steele Conor, Macnab Anita
Manchester University Foundation Trust, North West Heart Centre, Wythenshawe Hospital, Manchester, UK.
University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK.
Echo Res Pract. 2019 Jun 1;6(2):17-23. doi: 10.1530/ERP-18-0082.
The 2016 NICE clinical guideline 95 (CG95) demoted functional imaging to a second-line test following computed tomography coronary angiography (CTCA). Many cardiac CT services in the UK require substantial investment and growth to implement this. Chest pain services like ours are likely to continue to use stress testing for the foreseeable future. We share service evaluation data from our department to show that a negative stress echocardiogram can continue to be used for chest pain assessment.
1815 patients were referred to rapid access chest pain clinic (RACPC) between June 2013 and March 2015. 802 patients had stress echocardiography as the initial investigation. 446 patients had normal resting left ventricular (LV) systolic function and a negative stress echocardiogram. At least 24 months after discharge, a survey was carried out to detect major adverse cardiovascular events (MACE) (cardiac death, myocardial infarction, admission to hospital for heart failure or angina, coronary artery disease at angiography, revascularisation by angioplasty or coronary artery bypass grafting) within 2 years.
Overall, 351 patients were successfully followed up. The mean Diamond-Forrester (D-F) score and QRISK2 suggested a high pre-test probability (PTP) of coronary artery disease (CAD). There were nine deaths (eight non-cardiac deaths and one cardiac death). MACE occurred in four patients with a mean time of 17.5 months (11.6-23.7 months). The annual event rate was 0.6%.
A negative stress echocardiogram can reliably reassure patients and clinicians even in high PTP populations with suspected stable angina. It can continue to be used to assess stable chest pain post CG95.
2016年英国国家卫生与临床优化研究所（NICE）临床指南95（CG95）将功能成像降为计算机断层扫描冠状动脉造影（CTCA）后的二线检查。英国许多心脏CT服务需要大量投资和发展才能实施这一举措。像我们这样的胸痛服务机构在可预见的未来可能会继续使用负荷试验。我们分享我们科室的服务评估数据，以表明负荷超声心动图阴性仍可继续用于胸痛评估。
2013年6月至2015年3月期间，1815例患者被转诊至快速通道胸痛诊所（RACPC）。802例患者以负荷超声心动图作为初始检查。446例患者静息左心室（LV）收缩功能正常且负荷超声心动图阴性。出院至少24个月后，进行一项调查以检测2年内的主要不良心血管事件（MACE）（心源性死亡、心肌梗死、因心力衰竭或心绞痛住院、血管造影显示冠状动脉疾病、通过血管成形术或冠状动脉搭桥术进行血运重建）。
总体而言，351例患者成功随访。平均Diamond-Forrester（D-F）评分和QRISK2提示冠状动脉疾病（CAD）的预检概率（PTP）较高。有9例死亡（8例非心源性死亡和1例心源性死亡）。4例患者发生MACE，平均时间为17.5个月（11.6 - 23.7个月）。年事件发生率为0.6%。
即使在疑似稳定型心绞痛的高PTP人群中，负荷超声心动图阴性也能可靠地让患者和临床医生放心。在CG95发布后，它仍可继续用于评估稳定型胸痛。
