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Comparison of contrast echocardiography with Single-Photon emission computed tomographic myocardial perfusion imaging in the evaluation of patients with possible acute coronary syndromes in the emergency department

  • Michael C Kontos
    Affiliations
    Medical College of Virginia at Virginia Commonwealth University, Richmond, Virginia, USA

    Harborview Medical Center, Seattle, Washington, USA

    Southpoint Cardiology, Jacksonville, Florida, USA

    Molecular Biosystems, San Diego, California, USA

    Presbyterian Hospital, Dallas, Texas, USA
    Search for articles by this author
  • David Hinchman
    Affiliations
    Medical College of Virginia at Virginia Commonwealth University, Richmond, Virginia, USA

    Harborview Medical Center, Seattle, Washington, USA

    Southpoint Cardiology, Jacksonville, Florida, USA

    Molecular Biosystems, San Diego, California, USA

    Presbyterian Hospital, Dallas, Texas, USA
    Search for articles by this author
  • Michael Cunningham
    Affiliations
    Medical College of Virginia at Virginia Commonwealth University, Richmond, Virginia, USA

    Harborview Medical Center, Seattle, Washington, USA

    Southpoint Cardiology, Jacksonville, Florida, USA

    Molecular Biosystems, San Diego, California, USA

    Presbyterian Hospital, Dallas, Texas, USA
    Search for articles by this author
  • Jeffrey J Miller
    Affiliations
    Medical College of Virginia at Virginia Commonwealth University, Richmond, Virginia, USA

    Harborview Medical Center, Seattle, Washington, USA

    Southpoint Cardiology, Jacksonville, Florida, USA

    Molecular Biosystems, San Diego, California, USA

    Presbyterian Hospital, Dallas, Texas, USA
    Search for articles by this author
  • Jorge Cherif
    Affiliations
    Medical College of Virginia at Virginia Commonwealth University, Richmond, Virginia, USA

    Harborview Medical Center, Seattle, Washington, USA

    Southpoint Cardiology, Jacksonville, Florida, USA

    Molecular Biosystems, San Diego, California, USA

    Presbyterian Hospital, Dallas, Texas, USA
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  • J.V Nixon
    Correspondence
    Dr. Nixon’s address is: Division of Cardiology, Medical College of Virginia at VCU, 403 North 13th Street, Room 7077, Richmond, Virginia 23298, USA.
    Affiliations
    Medical College of Virginia at Virginia Commonwealth University, Richmond, Virginia, USA

    Harborview Medical Center, Seattle, Washington, USA

    Southpoint Cardiology, Jacksonville, Florida, USA

    Molecular Biosystems, San Diego, California, USA

    Presbyterian Hospital, Dallas, Texas, USA
    Search for articles by this author
      Most patients seen in emergency departments (EDs) for evaluation of chest pain are admitted to the hospital, although only a minority is ultimately diagnosed with an acute coronary syndrome (ACS).
      • Goldman L.
      • Cook E.F.
      • Brand D.A.
      • Lee T.H.
      • Rouan G.W.
      • Weisberg M.C.
      • Acampora D.
      • Stasiulewicz C.
      • Walshon J.
      • Terranova G.
      A computer protocol to predict myocardial infarction in emergency department patients with chest pain.
      Furthermore, 2% to 8% of patients diagnosed with an ACS are initially unrecognized and inadvertently discharged.
      • Lee T.H.
      • Rouan G.W.
      • Weisberg M.C.
      • Brand D.A.
      • Acampora D.
      • Stasiulewicz C.
      • Walshon J.
      • Terranova G.
      • Gottlieb L.
      • Goldstein-Wayne B.
      Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room.
      ,
      • McCarthy B.D.
      • Beshansky J.R.
      • D’Agostino R.B.
      • Selker H.P.
      Missed diagnoses of acute myocardial infarction in the emergency department results from a multicenter study.
      Accurate triage techniques are still required and continue to be assessed.
      • Tatum J.L.
      • Jesse J.L.
      • Kontos M.C.
      • Nicholson C.S.
      • Schmidt K.L.
      • Roberts C.S.
      • Ornato J.P.
      Comprehensive strategy for the evaluation and triage of the chest pain patient.
      ,
      • Kontos M.C.
      • Arrowood J.A.
      • Jesse R.L.
      • Ornato J.P.
      • Paulsen W.H.
      • Tatum J.L.
      • Nixon J.V.
      Comparison between 2-dimensional echocardiography and myocardial perfusion imaging in the emergency department in patients with possible myocardial ischemia.
      ,
      • Kontos M.C.
      • Arrowood J.A.
      • Paulsen W.H.
      • Nixon J.V.
      Early echocardiography can predict cardiac events in emergency department patients with chest pain.
      ,
      • Kontos M.C.
      • Jesse R.L.
      • Anderson F.P.
      • Schmidt K.L.
      • Ornato J.P.
      • Tatum J.L.
      Comparison of myocardial perfusion imaging and cardiac troponin I in patients admitted to the emergency department with chest pain.
      ,
      • Hilton T.C.
      • Fulmer H.
      • Abuan T.
      • Thompson R.C.
      • Stowers S.A.
      Ninety-day follow-up of patients in the emergency department with chest pain who undergo initial single-photon emission computed tomographic perfusion scintigraphy with technetium 99m-labeled sestamibi.
      Both myocardial contrast echocardiography (MCE) and single-photon emission computed tomographic imaging (SPECT) have been shown to be effective techniques for the evaluation of myocardial infusion.
      • Meza M.F.
      • Mobarek S.
      • Sonnemaker R.
      • Shuler S.
      • Ramee S.R.
      • Collins T.J.
      • White C.J.
      • Aristizabal D.
      • Murgo J.P.
      • Cheirif J.
      Myocardial contrast echocardiography in human beings correlation of resting perfusion defects to sestamibi single photon emission computed tomography.
      ,
      • Cohen J.L.
      • Cheirif J.
      • Segar D.S.
      • Gillam L.D.
      • Gottdiener J.S.
      • Hausnerova E.
      • Bruns D.
      Improved left ventricular endocardial border delineation and opacification with OPTISON (FS069), a new echocardiographic contrast agent. Results of a phase III Multicenter Trial.
      However, the use of MCE in ED patients for the evaluation of an ACS has not been examined. This study assessed the feasibility and safety of performing MCE in patients with acute chest pain. Myocardial perfusion and left ventricular wall motion analysis by MCE before and after administration of Optison (Molecular Biosystems, Inc., San Diego, California), an echocardiographic contrast agent, were compared with SPECT.
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