Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Feb 1;32(1):38-45.
doi: 10.1097/MEJ.0000000000001161. Epub 2024 Jul 10.

Diagnostic accuracy of point-of-care cardiac ultrasound for acute coronary syndromes in patients presenting with chest pain to the emergency department: a single-center prospective study

Paolo Bima  1   2   3 , Ilya Agishev  4 , Ilaria Fucile  4 , Giuliano de Stefano  4 , Fulvio Morello  1 , Christian Mueller  2   3 , Peiman Nazerian  4 ; WINFOCUS study group
Collaborators, Affiliations
Observational Study

Diagnostic accuracy of point-of-care cardiac ultrasound for acute coronary syndromes in patients presenting with chest pain to the emergency department: a single-center prospective study

Paolo Bima et al. Eur J Emerg Med. .

Abstract

Background and importance: The diagnostic accuracy of focused cardiac ultrasound (FoCUS) performed in patients presenting to the emergency department (ED) with chest pain is currently unknown.

Objective: The objective of this study was to assess the diagnostic accuracy of regional wall motion abnormalities detected with FoCUS for non-ST-elevation acute coronary syndrome (NSTE-ACS) diagnosis.

Design: A Single-center prospective observational study conducted in 2022 in the ED of the University Hospital Careggi, Italy.

Setting and participants: Adult patients presenting to the ED with acute nontraumatic chest pain were enrolled, irrespective of the presence of previous regional wall motion abnormalities. Patients with ST-segment elevation myocardial infarctions and patients with hemodynamic instability were excluded. FoCUS was performed at presentation by a trained ED physician.

Outcome measures and analysis: The final diagnosis of NSTE-ACS vs. alternative diagnosis was adjudicated by an ED physician blinded to FoCUS results after a 30-day follow-up. To assess if regional wall motion abnormalities were an independent predictor of NSTE-ACS, a multivariable logistic regression model was built. Diagnostic performance measures were calculated. A sensitivity analysis considering only type-1 NSTEMIs (i.e. plaque rupture/thrombosis) was conducted.

Main results: Among 686 patients, NSTE-ACS was adjudicated in 106 (15.5%) patients, 67 of which were NSTEMIs. A total of 87 (12.7%) patients had regional wall motion abnormalities detected by FoCUS, which were an independent predictor of NSTE-ACS in the multivariable logistic regression analysis. Regional wall motion abnormalities had a sensitivity of 42.5% (33.0-51.9), a specificity of 92.8% (90.6-94.9), a negative predictive value of 89.8% (87.4-92.2), and a positive predictive value of 51.7% (41.2-62.2), for NSTE-ACS. Results were consistent in the sensitivity analysis.

Conclusions: In ED patients with chest pain and no ST elevation, the detection of regional wall motion abnormalities was a predictor of NSTE-ACS. Despite a high specificity, which indicated a possible role of FoCUS in the rule-in of NSTE-ACS, sensitivity was too low to allow a safe rule-out using FoCUS results alone.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Morello F, Bima P, Ferreri E, Chiarlo M, Balzaretti P, Tirabassi G, et al. After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions. Intern Emerg Med. 2021; 16:1683–1690.
    1. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023; 44:3720–3826.
    1. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, et al. AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021; 144:e368–e454.
    1. Isselbacher EM, Preventza O, Iii JHB, Augoustides JG, Beck AW, Bolen MA, et al. ACC/AHA guideline for the diagnosis and management of aortic disease. J Am Coll Cardiol. 2022; 80:e223–e393.
    1. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing G-J, Harjola V-P, et al.; The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2019; 54:1901647–1901603.

Publication types