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.
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。