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Feasibility and possible cost-effectiveness of contrast echocardiography in the emergency room for the evaluation of chest pain syndromes

B. Diebold*

Hôpital Européen Georges Pompidou, Paris, France

* Correspondence: Professor Benoit Diebold, Hôpital Européen Georges Pompidou, Service de Cardiologie, 20 rue Leblanc, 75 908 Paris Cedex 15.

Abstract

The identification of a segmental wall motion abnormality has not thus far gained confidence in routine practice for the dignosis of acute myocardial infarction because of suboptimal sensitivity, in particular in patients with poor echogenicity. Recently developed contrast media have demonstrated a positive impact on this relatively low sensitivity. This improvement might lead to the introduction of contrast echocardiography in ‘rule out myocardial infarction’ protocols, provided that users are adequately trained. In patients with unstable angina and normal troponin values, a stress test is recommended to decide on the strategy. Stress echocardiography reportedly has both better sensitivity and specificity than exercise ECG, and has an overall accuracy similar to that of nuclear medicine. Because contrast further improves the performance of stress echocardiography, it might further decrease the need for nuclear medicine in the case of poorly delineated endocardium.

Key Words: Chset pain unit • contrast echocardiography • left ventricular opacification • myocardial perfusion


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