Hand-held echocardiographic examination of patients with symptoms of acute coronary syndromes in the emergency department: the 30-day outcome associated with normal left ventricular wall motion.

Background: Acute chest pain is a common complaint for patients presenting to emergency departments. Electrocardiography (ECG) results and biochemical markers have strong positive predictive value, but an equally available, inexpensive, and non-invasive test with strong negative predictive value is needed. Hand-held echocardiography (HHE) might serve this purpose. The objective of this study was to test the hypothesis that in patients with symptoms suggestive of acute coronary syndrome, non-diagnostic ECG, and normal biochemical markers, HHE-documented normal left ventricular function is not associated with a clinical diagnosis of acute myocardial ischemia or infarction, nor an ischemic event within 30 days of follow-up.

Methods: Assessment of left ventricular systolic function was performed in 150 patients with the HHE device. The incidences of the clinical end points of death, myocardial infarction, and ischemia were determined during the 30-day follow-up period. Data analysis included evaluation of specificity, sensitivity, and positive and negative predictive values.

Results: The incidence of acute myocardial infarction was 2.5% (2/78) in the normal HHE group and 20% (6/30) in the abnormal HHE group (P = .002). The incidence of either acute myocardial infarction or ischemia was 7.6% (6/78) in the normal HHE group and 14.6% (6/30) in the abnormal HHE group (P = .11). The negative predictive value of HHE was 91%.

Conclusions: These results suggest a possible role for HHE in providing additional diagnostic and prognostic information in the examination of patients with a low likelihood of myocardial ischemia or infarction and symptoms suggestive of acute coronary syndrome.