Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain
G Runza1, L La Grutta, V Alaimo
1Department of Radiology, University of Palermo, University Hospital P. Giaccone, Italy. grunza@sirm.org
Insights
ECG-gated multi-detector computed tomography (MDCT) offers a comprehensive approach for diagnosing acute chest pain in emergency rooms. This method efficiently evaluates cardiac and non-cardiac causes, aiding in patient triage and potentially reducing costs.
Area of Science:
- Radiology
- Emergency Medicine
- Cardiology
Background:
- Acute chest pain, including acute myocardial infarction, pulmonary embolism, and aortic dissection, presents diagnostic challenges in emergency settings.
- These conditions can lead to significant morbidity and mortality.
- Current diagnostic methods may not always be sufficient for rapid and comprehensive evaluation.
Purpose of the Study:
- To evaluate ECG-gated multi-detector computed tomography (MDCT) as a comprehensive tool for diagnosing acute chest pain in emergency department patients.
- To assess the feasibility and effectiveness of MDCT in evaluating both cardiac and non-cardiac causes of chest pain.
- To explore MDCT's role in patient triage for acute coronary syndrome and other serious chest pain etiologies.
Main Methods:
- Utilized ECG-gated multi-detector computed tomography (MDCT) to scan the entire thorax.
- Visualized thoracic aorta, pulmonary arteries, and coronary arteries.
- Assessed MDCT's logistical feasibility and diagnostic capabilities in an emergency department setting.
Main Results:
- MDCT is a logistically feasible and promising comprehensive method for evaluating cardiac and non-cardiac chest pain.
- The technique provides reliable information for triaging patients with acute coronary syndrome.
- MDCT offers rapid investigation of acute chest pain sources with a high negative predictive value and potential cost advantages.
Conclusions:
- ECG-gated MDCT represents a new approach to the triage of acute chest pain.
- The modality is effective for evaluating the main sources of acute chest pain.
- Patient selection for MDCT should be judicious to mitigate risks associated with ionizing radiation.
Abstract:
Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.
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