Echocardiography in the coronary care unit: diagnostic and prognostic impact in comparison with clinical and other indicators

• Published in: The American journal of cardiology Vol. 81; no. 12; pp. 13G - 16G
• Main Authors: Romano, Silvio, Varveri, Antonio, Aurigemma, Giuseppe, Dagianti, Alessandra, Vitarelli, Antonio, Sciomer, Susanna, Pastore, Luciano Raffale, Penco, Maria, Dagianti, Armando
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 18.06.1998; Elsevier Limited
• Subjects: Aged; Cardiology; Coronary Care Units; Diagnosis, Differential; Echocardiography, Doppler - methods; Female; Health care; Heart attacks; Humans; Italy; Male; Medical diagnosis; Medical screening; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - pathology; Pain; Predictive Value of Tests; Prognosis
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00047-2

The clinical arena in which we must consider the role of echocardiography is characterized by 2 fundamental findings: (1) most patients with chest pain and suspected acute myocardial infarction (MI) do not present diagnostic electrocardiograms; and (2) an early and correct diagnosis is necessary to match the patient with the most adequate treatment. Echocardiography may be very useful in the coronary care unit, allowing a correct diagnosis of ischemic heart disease when electrocardiography is unclear, even before the rise of cardiac enzymes is detected. It may also play a role in decision-making for thrombolytic therapy. In addition, echocardiography provides useful information for early risk stratification. In fact, although high-risk patients are well identified by simple clinical or instrumental variables (i.e., Killip classification, enzymatic data, blood–gas analysis, electrocardiogram, etc.), most patients (>60%) are identified as low risk, and several subjects classified into the low-risk groups have a poor prognosis and are not detected using a single variable. In our experience, 2-dimensional echocardiography was able to further stratify between patients of low-risk classes. Therefore, echocardiography plays an important role in the early stratification of acute MI patients, especially in those without signs or symptoms of heart failure.