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Updated: Sep 10, 2025
Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Bedside echocardiography in patients with suspected acute myocardial infarction without ST elevation
Paul Michael Haller1,2, Alina Schock3, Caroline Kellner3
1Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. p.haller@uke.de.
Insights
Bedside echocardiography did not significantly improve acute myocardial infarction diagnosis beyond troponin tests. However, echocardiography findings identified patients at higher risk of death, indicating a prognostic role.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Echocardiography is recommended alongside high-sensitivity cardiac troponin (hs-cTn) for suspected acute myocardial infarction (MI).
- Limited data exists on the diagnostic and prognostic value of echocardiography in this context.
Purpose of the Study:
- To evaluate the diagnostic performance of bedside echocardiography for acute MI.
- To assess the prognostic value of echocardiographic findings in patients with suspected MI.
Main Methods:
- Observational study of 2779 patients with suspected MI without ST elevation.
- Bedside echocardiography interpreted by cardiology fellows.
- Comparison of diagnostic accuracy (NPV, PPV) with hs-cTn algorithms.
- Cox regression analysis for all-cause mortality risk associated with echocardiographic findings.
Main Results:
- Echocardiography showed a low positive predictive value (PPV 8.9%) but high negative predictive value (NPV 95.6%) for MI.
- Patients with pathological echocardiographic findings had a significantly increased risk of all-cause death (HR 1.36).
Conclusions:
- Bedside echocardiography did not substantially improve acute MI diagnostic accuracy beyond hs-cTn protocols in the observed group.
- Echocardiographic findings are valuable for identifying high-risk patients.
- Further prospective studies are needed to establish the role of bedside echocardiography.
Background:
Guidelines recommend using echocardiography in addition to high-sensitivity cardiac troponin (hs-cTn)-based assessment in patients with suspected acute myocardial infarction (MI), although data on its diagnostic and prognostic value is limited.
Methods:
Patients presenting with suspected MI without ST elevation to a tertiary center were enrolled. Final diagnoses were adjudicated by two cardiologists. Trained cardiology fellows conducted and interpreted bedside echocardiography in the emergency department as standard of care. Diagnostic performance measures (negative and positive predictive values [NPV, PPV] [95% confidence intervals]) to rule-in or rule-out MI were compared for patients with and without any pathological finding (any wall-motion abnormalities [WMA] or systolic left ventricular dysfunction) in patients assigned to the observe group by a 0/1-hs-cTnI-algorithm. Cox regression analysis was conducted to investigate the association of pathological findings with all-cause death.
Results:
Overall, 2779 patients with available echocardiography were included (median age 63 years, 366 [13.2%] with MI, 2158 [77.6%] with data on WMA, median follow-up 5.2 years). The PPV to identify MI using bedside echocardiography in the observe group was low (PPV 8.9 [6.3, 12.5]), and the NPV was 95.6 [93.9, 96.9]. After adjustment for relevant covariates, patients with any compared to no pathological finding were at increased risk for all-cause death during follow-up (HR 1.36 [1.06, 1.74], p = 0.014).
Conclusions:
In this observational study, it could not be shown that bedside echocardiography in the context of suspected acute MI without ST elevation substantially improves diagnostic accuracy beyond hs-cTn-based diagnostic protocols to identify MI in patients assigned to the observe zone. However, findings on echocardiography helped to identify high-risk patients. More prospective evidence on the use of bedside echocardiography is needed to increase the body of evidence. Trial registration ClinicalTrials.gov Identifier: NCT02355457.
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