Point-of-Care Echocardiography and Regional Wall-Motion Abnormalities in Acute Coronary Syndromes

Previous studies demonstrate that acute coronary syndromes (ACS) cause cardiac regional wall-motion abnormalities (RWMA) identifiable with comprehensive echocardiography (CE). Emerging evidence supports emergency physician (EP)-performed point-of-care cardiac echocardiography (POCE) to detect RWMA in ACS.

The objective of this study is to evaluate the degree to which EP-performed POCE can accurately identify RWMA in patients presenting with concern for ACS.

This retrospective review evaluated patients presenting to two emergency departments over 26 months, with high clinical suspicion for ACS and EP diagnosis of RWMA on POCE. All POCE were performed by EPs with advanced emergency ultrasound training. Data regarding a patient's clinical course were abstracted and compared against EP performed POCE.

Twenty-seven patients were enrolled. Six (22.2%) presented with ST segment elevation myocardial infarctions (STEMI) and all had POCE with RWMA corresponding with ischemia on ECG. Fifteen (55.6%) had non-STEMI. Twenty-one (77.8%) patients had CE performed that confirmed RWMA seen on POCE (100%). Of 16 (59.3%) patients who underwent cardiac catheterizations, 14 (87.5%) had coronary lesions compatible with the distribution of RWMA seen on POCE and two (12.5%) had alternate diagnoses (takotsubo cardiomyopathy and myocarditis). Ten (37.0%) patients were transferred from community hospitals. Seven (70.0%) transferred patients were diagnosed with non-STEMI.

POCE performed by trained EPs consistently identified RWMA in patients presenting with chest pain and clinical concern for ACS. POCE may be a useful adjunct in identifying a subset of high-risk chest pain patients in the ED who could benefit from expedited care, particularly those not meeting STEMI activation criteria.