Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation†

Abstract

AIMS: 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. METHODS AND RESULTS: 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). CONCLUSION: 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.