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Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

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An Erratum to this article was published on 18 June 2015

Abstract

Left ventricular strain echocardiography is reported to be more sensitive in detecting myocardial ischemia than conventional transthoracic echocardiography (TTE). We evaluated the usefulness of 2D strain analysis for the assessment of acute chest pain in emergency department (ED). Patients presenting to ED with acute chest pain were recruited. Patients with ST-elevation myocardial infarction, known coronary artery disease (CAD), non-ischemic cardiomyopathy, or non-cardiac chest pain were excluded. The pretest probability of CAD and TTEs were evaluated in all patients. TTEs included visual assessments of regional wall motion abnormality (RWMA) and analysis of global and regional longitudinal strain (GLS and RLS). The diagnosis of CAD and the occurrence of cardiac events during 1 month after ED visit were reviewed. Cardiac events were observed in 25 % of total 104 patients, and CAD was detected in 36 % of 69 patients with coronary imaging tests. Compared to RWMA, RLS showed higher sensitivity (sensitivity/specificity = 64/89 vs. 92/77 %) with similar diagnostic accuracy (79.7 vs. 82.6 %, p = 0.791) for CAD. RLS also demonstrated better diagnostic performance than either GLS (sensitivity/specificity = 92/57 %) or pretest probability (sensitivity/specificity = 72/64 %). Similarly, RLS had the higher predictive value for 1-month cardiac events. In multivariable analyses including pretest probability, LVEF, RWMA, cardiac enzyme, GLS, and RLS; only pretest probability (OR 1.91, 95 % CI 1.22–2.99, p = 0.005) and RLS (OR 25.42, 95 % CI 1.84–342.04, p = 0.016) independently predicted CAD. Strain echocardiography appears to be effective in diagnosing CAD and predicting future events with high sensitivity and negative predictive value in acute chest pain patients visiting ED.

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Acknowledgments

We would like to acknowledge the echocardiographers at the Samsung Medical Center; Ji-Hye Gwak, Yu-Rim Han, Bo-Kyoung Kang, Ji-Soo Jeong, and Yun-A Kim.

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Authors and Affiliations

  1. Seoul, Republic of Korea

    Mirae Lee, Sung-A Chang, Eun Jeong Cho, Sung-Ji Park, Jin-Oh Choi, Sang-Chol Lee, Jae K. Oh & Seung Woo Park

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  1. Mirae Lee
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Correspondence to Sung-A Chang.

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Lee, M., Chang, SA., Cho, E.J. et al. Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department. Int J Cardiovasc Imaging 31, 547–556 (2015). https://doi.org/10.1007/s10554-015-0588-z

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