Stress Echo for Patients with Chest Pain in ED

A study has shown that stress pharmacologic echocardiography can help distinguish which patients with chest pain have coronary artery disease and which have only anxiety. The study was presented at the annual congress of the European Society of Cardiology (ESC) in Berlin (Germany).

A trial called SPEED (stress pharmacologic echocardiography in emergency department) involved more than 500 patients from Italy, Argentina, and Brazil, who were recruited by six different stress echocardiography labs. All had acute chest pain syndrome with negative serial enzyme cardiac markings and electrocardiogram (ECG) recordings. All underwent pharmacologic stress echocardiography. The test positivity consisted of new wall motion abnormalities detected by echocardiographic monitoring during infusion of a drug, usually dipyridamole, capable of inducing ischemia in patients with coronary artery disease. Patients with a positive stress echo were admitted to a coronary care unit and were almost invariably found to have coronary artery disease during angiography. An ischemia-guided revascularization with angioplasty was the most frequent therapeutic choice.

The majority of patients, however, had a negative stress echo (no inducible ischemia and no wall motion abnormalities) were discharged home, usually without experiencing cardiac events in the subsequent one-year follow-up. In short, out of 10 patients otherwise ready for discharge, at least one has true myocardial ischemia detected by stress echo. The remaining nine can be discharged and have a probability lower than 1% of having a heart attack in the following 12 months.

The research was presented by Dr. Eugenio Picano, of the CNR, Institute of Clinical Physiology (Pisa, Italy).



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