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Yang X, Zhang F, Chen Y, Shao X, Wang J, Zhang S, Shi G, Yang M, Wu Z, Li S, Wang Y. Value of rest 18F-FDG myocardial imaging in the diagnosis of obstructive coronary artery disease in Chinese patients with suspected unstable angina: A prospective real-world clinical study. J Nucl Cardiol 2023; 30:214-226. [PMID: 35915328 DOI: 10.1007/s12350-022-03068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to determine the clinical value of rest 18F-FDG imaging in Chinese patients with non-acute chest pain, normal ECG, negative troponin, and suspected UA. METHODS 136 patients were prospectively included and underwent rest 18F-FDG PET imaging and coronary arteriography within 1 week. RESULTS Obstructive CAD was diagnosed in 71 patients, and stenosis ≥ 70% was confirmed in 130 vascular territories. At patients and vascular level, rest 18F-FDG imaging showed sensitivity of 62.0%, 47.7%, specificity of 92.3%, 94.2%, accuracy of 76.5%, 79.4%, PPV of 89.8% and 79.5%, and NPV of 69.0% and 79.4%. The AUCs were 0.771 and 0.710. Of 71 patients with obstructive CAD, rest 18F-FDG imaging showed sensitivity of 47.7% and 58.8%, specificity of 91.6% and 91.2%, accuracy of 64.8% and 80.4%, PPV of 89.9% and 76.9% and NPV of 52.8% and 81.6% in all vascular level and single-vessel disease. In patients with two- or three-vessel disease, rest 18F-FDG imaging had a diagnostic sensitivity, specificity, accuracy, PPV, and NPV of 43.8%, 93.3%, 50.5%, 97.7%, and 20.6%. The AUCs were 0.696, 0.750, and 0.685. CONCLUSION Rest 18F-FDG imaging performed certain overall diagnostic efficiency for obstructive CAD in Chinese patients with suspected UA, especially the excellent high PPV in identifying culprit ischemic territory in patients with multivessel disease.
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Affiliation(s)
- Xiaoyu Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu Province, China
- Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yongjun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu Province, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu Province, China
| | - Sheng Zhang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Guiliang Shi
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Minfu Yang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhifang Wu
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Sijin Li
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China.
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu Province, China.
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Haring B, Schmidt A, Frantz S. [Acute Chest Pain: A Stepwise Approach to Management]. Pneumologie 2021; 75:901-909. [PMID: 34788891 DOI: 10.1055/a-1238-5254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.
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Rasooli F, Bagheri F, Sadatnaseri A, Ashraf H, Bahreini M. Comparison of Emergency Echocardiographic Results between Cardiologists and an Emergency Medicine Resident in Acute Coronary Syndrome. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e53. [PMID: 34405151 PMCID: PMC8366461 DOI: 10.22037/aaem.v9i1.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Early detection of regional wall motion abnormality (RWMA) can be a reliable tool for rapid disposition of patients with acute coronary syndrome (ACS) in the emergency department. In this study, the diagnostic accuracy of point-of-care echocardiography performed by a trained emergency medicine resident was evaluated in comparison with board-certified cardiologists. METHODS A prospective, cross-sectional study was implemented on adult patients with ACS. A trained emergency medicine (EM) PGY-3 resident performed point-of-care echocardiography under the supervision of two cardiologists and the reports were compared with cardiologists as a reference test. RESULTS 100 patients with the mean age of 54.1 ± 11.5 years were recruited (65% male). Based on Thrombolysis in Myocardial Infarction (TIMI) and History, EKG, Age, Risk factors, and troponin (HEART) scores, 43.0% and 25.0% of patients were categorized as low-risk for ACS, respectively. The absolute measure of agreement between cardiologists to determine ejection fraction (EF) was 0.829 (95% CI: 0.74-0.89) based on intraclass correlation coefficient (ICC) estimation. The measurements of agreement between specialists and the EM resident based on the analysis of Kappa coefficient were 0.677 and 0.884 for RWMA and pericardial effusion, respectively. Moreover, 25 patients were in the-low risk group according to the HEART score with an agreement rate of 92% for the lack of RWMA between the EM resident and cardiologists. CONCLUSION This study found acceptable agreement between the EM resident and cardiologists in assessing RWMA in different ACS risk groups. In addition, there was acceptable agreement between the EM resident and cardiologists in determining left ventricular ejection fraction (LVEF) and pericardial effusion.
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Affiliation(s)
- Fatemeh Rasooli
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Bagheri
- Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Sadatnaseri
- Cardiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Cardiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bahreini
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Emergency Medicine Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Huang YC, Sung SF, Liu KT. Painless Acute Aortic Dissection May Present as a Stroke; Risky Markers that Could be Identified on Hospital Arrival. J Acute Med 2017; 7:93-100. [PMID: 32995179 PMCID: PMC7517928 DOI: 10.6705/j.jacme.2017.0703.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/01/2016] [Accepted: 01/12/2017] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Acute aortic dissection (AAD) is a life-threatening emergency. A small portion of AAD patients presents as an acute stroke without chest pain. A missed or delayed diagnosis of AAD often brings catastrophic outcome. We aimed to identify clinical markers suggestive of the presence of painless AAD in acute stroke patients. METHODS From January 2007 through December 2014, painless AAD patients were retrospectively collected from our stroke registry. We expanded the search by reviewing Medline and the Science Citation Index Expanded from 1981 until March 2015. We enrolled 200 consecutive cases of acute ischemic stroke without AAD as the control. Univariate analyses were performed to compare clinical markers, followed by logistic regression to analyze the markers with signifi cant differences. RESULTS The AAD group had more female, younger patients and fewer co-morbidities. They more frequently had consciousness disturbances (p < 0.001), were brought to the hospital sooner (p < 0.001), arrived more frequently with impaired consciousness (p = 0.001), hypotension and bradycardia (p < 0.001) and left-sided weakness (70.2%; p < 0.001). In the risk factor analysis, hypotension (OR 48.86, 95% CI 5.70-420.28), bradycardia (OR 8.11, 95% CI 2.71-24.24), initial loss of consciousness (OR 5.27, 95% CI 1.88-14.76), andleft-sided weakness (OR 3.31, 95% CI 1.17-9.40) were observed more frequently in the AAD group. CONCLUSIONS Consider to rule out a painless AAD in stroke patients presenting with hypotension, bradycardia, initial loss of consciousness, or left-sided weakness.
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Affiliation(s)
- Ying Chieh Huang
- Chiayi Christian Hospital Department of Emergency Medicine Chiayi Taiwan
- Kaohsiung Medical University Department of Emergency Medicine, Medical Center and School of Medicine Kaohsiung Taiwan
| | - Sheng Feng Sung
- Chiayi Christian Hospital Division of Neurology, Department of Medicine Chiayi Taiwan
| | - Kuan Ting Liu
- Kaohsiung Medical University Department of Emergency Medicine, Medical Center and School of Medicine Kaohsiung Taiwan
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Yassin F, Sawh C, Garg P. Chest Pain of Uncertain Aetiology: Role of Contrast Enhanced Computed Tomography in the Emergency Department. Open Cardiovasc Med J 2016; 10:205-211. [PMID: 27733870 PMCID: PMC5054506 DOI: 10.2174/1874192401610010205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 11/22/2022] Open
Abstract
There is increasing role of computed tomographic (CT) in the assessment of acute chest pain in the emergency department especially when the diagnosis is not clear. We report a case where non ECG gated contrast enhanced CT in the emergency department for rule-out of pulmonary embolus guided to the actual diagnosis, which was, acute coronary event, as evidenced by the presence of perfusion defect.
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Affiliation(s)
- Firas Yassin
- Cardiothoracic Unit, Chesterman Wing, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Chris Sawh
- Cardiothoracic Unit, Chesterman Wing, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pankaj Garg
- Cardiothoracic Unit, Chesterman Wing, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Multidisciplinary Cardiovascular Research Centre & Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Abstract
Noninvasive cardiac imaging has an important role in the assessment of patients with acute-onset chest pain. In patients with suspected acute coronary syndrome (ACS), cardiac imaging offers incremental value over routine clinical assessment, the electrocardiogram, and blood biomarkers of myocardial injury, to confirm or refute the diagnosis of coronary artery disease and to assess future cardiovascular risk. This Review covers the current guidelines and clinical use of the common noninvasive imaging techniques, including echocardiography and stress echocardiography, computed tomography coronary angiography, myocardial perfusion scintigraphy, positron emission tomography, and cardiovascular magnetic resonance imaging, in patients with suspected ACS, and provides an update on the developments in noninvasive imaging techniques in the past 5 years.
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