{Reference Type}: Journal Article
{Title}: Systematic hand-held echocardiography in patients hospitalised with acute coronary syndrome.
{Author}: Geers J;Balfour A;Molek P;Barron P;Botezatu S;Joshi SS;White A;Buchwald M;Everett R;McCarley J;Cusack D;Japp AG;Gibson PH;Lang CCE;Stirrat C;Grubb NR;Bing R;Cruden NL;Denvir MA;Soliman Aboumarie H;Cosyns B;Newby DE;Dweck MR;
{Journal}: Eur Heart J Cardiovasc Imaging
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 11
{Factor}: 9.13
{DOI}: 10.1093/ehjci/jeae149
{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.