Evidence map›Paper›PMID 26349786›Full record

ArticleClinical research in cardiology : official journal of the German Cardiac Society2016

Myocardial deformation by strain echocardiography identifies patients with acute coronary syndrome and non-diagnostic ECG presenting in a chest pain unit: a prospective study of diagnostic accuracy.

Joerg Schroeder, Sandra Hamada, Nina Gründlinger, Tanja Rubeau, Ertunc Altiok, Katrin Ulbrich, Andras Keszei, Nikolaus Marx, Michael Becker

Abstract readEvaluation Study
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In one paragraph

Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed.

  1. Differential effects of inhibition of interleukin 1 and 6 on myocardial, coronary and vascular function.Clinical research in cardiology : official journal of the German Cardiac Society · 2019
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  12. Tocilizumab improves oxidative stress and endothelial glycocalyx: A mechanism that may explain the effects of biological treatment on COVID-19.Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association · 2020
    Article
  13. Novel ECG-based scoring tool for prediction of takotsubo syndrome.Clinical research in cardiology : official journal of the German Cardiac Society · 2019
    Article
  14. Cardiac sarcoidosis: a challenging diagnosis.Clinical research in cardiology : official journal of the German Cardiac Society · 2018
    Article
  15. Acute coronary syndrome due to right coronary spasm and documented lambda-like J waves.Clinical research in cardiology : official journal of the German Cardiac Society · 2018
    Article
  16. Point-of-care testing of cardiac autonomic function for risk assessment in patients with suspected acute coronary syndromes.Clinical research in cardiology : official journal of the German Cardiac Society · 2017
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Joerg SchroederDepartment of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
Sandra HamadaDepartment of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
Nina GründlingerDepartment of Internal Medicine, Hospital St. Brigida, Simmerath, Germany.
Tanja RubeauDepartment of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
Ertunc AltiokDepartment of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
Katrin UlbrichDepartment of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
Andras KeszeiDepartment of Medical Statistics, RWTH Aachen University, Aachen, Germany.
Nikolaus MarxDepartment of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
Michael BeckerDepartment of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany. mibecker@ukaachen.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveClinical assessment often cannot risk stratify patients hospitalized with chest pain and non-diagnostic electrocardiography (ECG) or myocardial enzymes. An inappropriate admission of patients with non-cardiac chest pain is an enormous cost factor.

methods2315 patients who presented in the chest pain unit (CPU) with symptoms suggestive of acute coronary syndrome (ACS) were screened. All patients with relevant changes in ECG or myocardial enzymes were excluded. 268 consecutive patients (mean 58 ± 7 years, 88 men) were prospectively included and underwent echocardiography for left ventricular ejection fraction (LVEF), wall motion score index (WMSI) and strain parameter and a coronary angiography (CA) within 2 ± 1 days after admission.

resultsAnatomically obstructive coronary artery disease (CAD) (≥70 % diameter stenosis) was present in 110 patients (41 %). The incremental value of LVEF, WMSI, and strain parameters to relevant clinical variables was determined in nested Cox models. Baseline clinical data associated with relevant CAD were age [hazard ratio (HR) 1.31, p = 0.03], arterial hypertension (HR 1.39, p = 0.03) and diabetes (HR 1.46, p = 0.001). The addition of endocardial global circumferential strain (GCS) (HR 1.57, p < 0.001) caused the greatest increment in model power (χ (2) = 43.4, p < 0.001). Optimal cut-off value was calculated as -21.7 % for GCS (sensitivity 87 %, specificity 76 %) to differentiate between these patients.

conclusionsIn patients with suspected ACS but without ECG changes or myocardial enzyme abnormalities, myocardial deformation imaging can identify patients at risk. This approach may be applied to improve decision guidance at the CPU for fast discharge of patients with non-cardiac chest pain or prompt cardiological allocation of patients with CAD. CLINICAL

trial registrationNCT 02357641.

Indexed as

ElectrocardiographyStroke VolumeVentricular Function, LeftAcute Coronary SyndromeAgedAngina PectorisArea Under CurveBiomechanical PhenomenaChi-Square DistributionCoronary AngiographyCoronary StenosisEchocardiographyFemaleHumansMaleMiddle AgedChest pain unitCoronary artery diseaseEchocardiographyMyocardial deformation imaging

Identifiers

PMID26349786

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.