Echocardiographic findings in patients with acute coronary syndrome and normal angiogram
A Germing1, S Ulrich, T Fadgyas
1Medical Clinic II, Cardiology and Angiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany. alfried.germing@rub.de
Insights
Echocardiography reveals significant findings in acute coronary syndrome patients with normal angiograms. Approximately one-third show wall motion abnormalities, highlighting echocardiography
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Acute coronary syndrome (ACS) often involves coronary artery blockages.
- Normal coronary angiograms in ACS patients can indicate non-obstructive causes of ischemia.
- Left ventricular wall motion abnormalities are common indicators of myocardial ischemia.
Purpose of the Study:
- To investigate echocardiographic findings in patients presenting with ACS but having normal coronary angiograms.
- To determine the clinical relevance of echocardiography in ACS patients without significant coronary artery disease.
Main Methods:
- Retrospective analysis of 897 patients diagnosed with ACS.
- Coronary angiography performed immediately after diagnosis.
- Standardized risk stratification and routine echocardiographic assessment for a subgroup with normal angiograms.
Main Results:
- Out of 897 ACS patients, 76 (8.5%) had normal coronary angiograms.
- Echocardiography revealed reduced left ventricular systolic function in 21.1% of these patients.
- Segmental wall motion abnormalities were detected in 32.9% of patients with normal angiograms.
Conclusions:
- Echocardiography is clinically relevant for ACS patients with normal angiograms, detecting significant myocardial dysfunction.
- Routine echocardiographic evaluation is recommended for suspected ACS, irrespective of angiographic findings.
- Further research should explore advanced echocardiographic techniques like contrast and tissue Doppler imaging.
Abstract:
Coronary angiograms performed at the time of an acute coronary syndrome typically present vessel occlusions, ruptured plaques or thrombotic lesions that require reperfusion therapy. However, occasionally, no coronary artery stenoses are detected. Myocardial ischemia frequently causes left ventricular wall motion abnormalities that can be seen easily by echocardiography. In our study we aimed to analyze echocardiographic findings in patients with acute coronary syndrome and normal angiogram. After standardized risk stratification, a total of 897 patients were classified as an acute coronary syndrome and underwent a coronary angiography immediately. In 76/897 patients angiography excluded coronary macroangiopathy. Routine echocardiographic assessment in patients with normal angiogram showed in 21.1% a reduced left ventricular systolic function and 32.9% presented with segmental wall motion abnormalities. In summary, by detection of segmental wall motion abnormalities in 1/3 of patients with suspected acute coronary syndrome and normal angiogram, obviously, an echocardiographic evaluation in this patient population is of clinical relevance. Recommendations for performing echocardiography in patients with suspected acute coronary syndromes independent of angiographic findings are strongly supported. Further analyses should implement echocardiographic techniques as contrast and tissue doppler imaging.
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