Wall motion abnormalities by two-dimensional echocardiography for detection of myocardial ischemia in the emergency unit

ABSTRACT

Inappropriate discharge from the emergency unit of patients with acute chest pain may have serious consequences. According to the ischaemic cascade, left ventricular wall motion abnormality is one of the first signs of myocardial ischemia and can be detected with two dimensional echocardiography [2DE]. This study was designed to determine the value of 2DE in the emergency unit for immediate detection of myocardial ischemia causing acute chest pain at the time the electrocardiogram was nondiagnostic. This study was carried out on 35 patients admitted to the Cardiology Department, Al-Hussein University Hospital, during the period from April, 1997 to May, 1998. Patients [24 men and 11 women] with a normal or nondiagnostic electrocardiogram during acute chest pain were studied with 2DE. Only patients without a previous myocardial infarction and without known coronary artery disease [CAD] were studied. The entire left ventricular wall was examined for presence of regional asynergy. Cardiac enzyme levels were measured serially to establish or rule out an acute myocardial infarction. Coronary angiography was performed within 2 weeks. Left ventricular asynergy was found in 22 out of the 35 patients recruited in this study. Coronary artery disease was found during coronary angiography in 19 out of the 22 patients with 2DE asynergy and in 2 out of the 13 patients with normal wall motion. Sensitivity of 2DE for detection of myocardial ischaemia was 90% [19 of 21], specificity 79% [11 of 14], negative predictive accuracy 85% [11 of 13] and positive predictive accuracy 86% [19 of 22]. Acute myocardial infarction was found in 12 out of the 22 patients with left ventricular asynergy and in 1 patient with normal wall motion. Sensitivity of 2DE for detection of acute myocardial infarction was 92% [12 of 13], specificity 55% [12 of 22], positive predictive accuracy was 55% [12 of 22] and negative predictive accuracy 92% [12 of 13]. Finally, it was concluded that 2DE can be used in the emergency unit to identify patients with CAD during pain and a nonconclusive electrocardiogram, and it can accurately rule out an acute myocardial infarction