Abstract：
OBJECTIVE: Transthoracic echocardiography is recommended in all patients with acute coronary syndrome but is time-consuming and lacks an evidence base. We aimed to assess the feasibility, diagnostic accuracy and time-efficiency of hand-held echocardiography in patients with acute coronary syndrome and describe the impact of echocardiography on clinical management in this setting.
RESULTS: Patients with acute coronary syndrome underwent both hand-held and transthoracic echocardiography with agreement between key imaging parameters assessed using kappa statistics. The immediate clinical impact of hand-held echocardiography in this population was systematically evaluated.Overall, 262 patients (65±12 years, 71% male) participated. Agreement between hand-held and transthoracic echocardiography was good-to-excellent (kappa 0.60-1.00) with hand-held echocardiography having an overall negative predictive value of 95%. Hand-held echocardiography was performed rapidly (7.7±1.6 min) and completed a median of 5 [interquartile range 3-20] hours earlier than transthoracic echocardiography. Systematic hand-held echocardiography in all patients with acute coronary syndrome identified an important cardiac abnormality in 50% and the clinical management plan was changed by echocardiography in 42%. In 85% of cases, hand-held echocardiography was sufficient for patient decision-making and transthoracic echocardiography was no longer deemed necessary.
CONCLUSIONS: In patients with acute coronary syndrome, hand-held echocardiography provides comparable results to transthoracic echocardiography, can be more rapidly applied and gives sufficient imaging information for decision-making in the vast majority of patients. Systematic echocardiography has clinical impact in half of patients, supporting the clinical utility of echocardiography in this population, and providing an evidence-base for current guidelines.
RESULTS: Patients with acute coronary syndrome underwent both hand-held and transthoracic echocardiography with agreement between key imaging parameters assessed using kappa statistics. The immediate clinical impact of hand-held echocardiography in this population was systematically evaluated.Overall, 262 patients (65±12 years, 71% male) participated. Agreement between hand-held and transthoracic echocardiography was good-to-excellent (kappa 0.60-1.00) with hand-held echocardiography having an overall negative predictive value of 95%. Hand-held echocardiography was performed rapidly (7.7±1.6 min) and completed a median of 5 [interquartile range 3-20] hours earlier than transthoracic echocardiography. Systematic hand-held echocardiography in all patients with acute coronary syndrome identified an important cardiac abnormality in 50% and the clinical management plan was changed by echocardiography in 42%. In 85% of cases, hand-held echocardiography was sufficient for patient decision-making and transthoracic echocardiography was no longer deemed necessary.
CONCLUSIONS: In patients with acute coronary syndrome, hand-held echocardiography provides comparable results to transthoracic echocardiography, can be more rapidly applied and gives sufficient imaging information for decision-making in the vast majority of patients. Systematic echocardiography has clinical impact in half of patients, supporting the clinical utility of echocardiography in this population, and providing an evidence-base for current guidelines.
摘要：
目的：所有急性冠脉综合征患者均推荐经胸超声心动图检查，但耗时且缺乏证据基础。我们的目的是评估可行性，手持式超声心动图在急性冠脉综合征患者中的诊断准确性和时间效率，并描述超声心动图对这种情况下临床管理的影响。
结果：急性冠脉综合征患者接受了手持和经胸超声心动图检查，使用kappa统计评估的关键成像参数之间的一致性。系统评估了手持式超声心动图在该人群中的直接临床影响。总的来说,262名患者（65±12岁，71%男性）参加。手持式和经胸超声心动图之间的一致性从好到优（κ0.60-1.00），手持式超声心动图的总体阴性预测值为95％。手持式超声心动图快速进行（7.7±1.6分钟），并且比经胸超声心动图提前5[四分位数间距3-20]小时。在所有急性冠状动脉综合征患者中，系统的手持式超声心动图确定了50％的重要心脏异常，而42％的超声心动图改变了临床管理计划。在85%的案例中，手持式超声心动图足以进行患者决策,经胸超声心动图不再被认为是必要的.
结论：在急性冠脉综合征患者中，手持式超声心动图提供了与经胸超声心动图相当的结果，可以更快速地应用，并为绝大多数患者的决策提供足够的成像信息。系统超声心动图对一半患者有临床影响，支持超声心动图在这一人群中的临床应用，并为当前指南提供证据基础。
结果：急性冠脉综合征患者接受了手持和经胸超声心动图检查，使用kappa统计评估的关键成像参数之间的一致性。系统评估了手持式超声心动图在该人群中的直接临床影响。总的来说,262名患者（65±12岁，71%男性）参加。手持式和经胸超声心动图之间的一致性从好到优（κ0.60-1.00），手持式超声心动图的总体阴性预测值为95％。手持式超声心动图快速进行（7.7±1.6分钟），并且比经胸超声心动图提前5[四分位数间距3-20]小时。在所有急性冠状动脉综合征患者中，系统的手持式超声心动图确定了50％的重要心脏异常，而42％的超声心动图改变了临床管理计划。在85%的案例中，手持式超声心动图足以进行患者决策,经胸超声心动图不再被认为是必要的.
结论：在急性冠脉综合征患者中，手持式超声心动图提供了与经胸超声心动图相当的结果，可以更快速地应用，并为绝大多数患者的决策提供足够的成像信息。系统超声心动图对一半患者有临床影响，支持超声心动图在这一人群中的临床应用，并为当前指南提供证据基础。
