| Background and ObjectivesChest pain is one of the most common symptoms in the emergency department,and cardiovascular chest pain is often fatal,such as ACS(Acute coronary syndrome)、PE(Pulmonary embolism)、AD(Aortic dissection).Therefore,the top priority of the ED chest pain room is to quickly identify these fatal chest pains.In recent years,with the continuous improvement of acoustic equipment,portable bedside ultrasonic diagnostic instrument provides key imaging diagnostic evidence for cardiovascular diseases,and has become an important means of emergency cardiovascular diseases examination in hospitals.Previous studies on the diagnosis of echocardiography in AMI were mostly performed after admission,and there was no further study on the influencing factors related to WMA in AMI patients.Methods518 moderate or high risk chest pain patients(HEART Score≥4)admitted to the ED of Shenzhen Luohu People’s Hospital from August 2018 to July 2021 were retrospectively analyzed.And their demographic characteristics,medical history,hs-c Tn I data,electrocardiogram and emergency point-of-care ultrasound results were collected for statistical analysis.To evaluate the value of emergency point-of-care ultrasound in diagnosis of different cardiovascular chest pain.Then,175 patients with AMI were divided into two groups according to whether WMA occurred,to discuss the related influencing factors of WMA.Results1.The differential diagnostic value of emergency point-of-care ultrasound:Among the 518 patients with chest pain(HEART score ≥4),352 were at moderate risk and 181 were at high risk.Point-of-care ultrasound assisted in the diagnosis of AMI in 127 cases(24.52%),AD in 4 cases(0.77%),PE in 2 cases(0.39%),heart failure in 26 cases(5.02%),dilated cardiomyopathy in 4 cases(0.77%),hypertrophic cardiomyopathy in 1 case(0.19%),rheumatic heart disease in 2 cases(0.39%),arrhythmia in 41 cases(7.92%),viral myocarditis in 2 cases(0.39%),and 139 cases(26.83%)of other non-cardiogenic chest pain.48 cases of AMI(9.27%)and 1 case(0.19%)of AD were not accurately identified.The incidence of MACE was 13.92%(49 cases)in 352 patients with moderate risk chest pain and 75.90%(126 cases)in 166 patients with high risk chest pain.Compared with the diagnosis of the first hs-c Tn I and ECG in the ED,MACE in patients with moderate risk chest pain was better identified by point-of-care ultrasound(65.31% VS 40.82%),p < 0.05.For patients with chest pain at 4-5 points,emergency point-of-care ultrasound was more sensitive than the first hs-c Tn I in the ED to identify MACE(p < 0.05),and for patients with chest pain ≥6 points,there was no significant difference between them(p > 0.05).HEART score alone predicted the incidence of MACE with an area under ROC curve of0.901(95%CI,0.877-0.925),while combined with point-of-care ultrasound predicted the incidence of MACE with an area under ROC curve of 0.983(95%CI,0.976-0.990).Emergency point-of-care ultrasound was used to predict MACE in patients with chest pain with a HEART Score of 4-5,and the sensitivity,specificity,positive predictive value,and negative predictive were 78.57%,100%,100%,and 98.9%.And in patients with chest pain with HEART score≥6,they were 72.05%,100%,100%,61.86%.2.Influencing factors of WMA: By emergency point-of-care echocardiography,127patients(72.57%)were found to have WMA,while 48 patients(27.43%)had no WMA.Compared with no WMA group,in term of gender,onset time,hypertension,diabetes,cardiovascular and cerebrovascular diseases,smoking and obesity were no significant differences(P > 0.05).The age of WMA group(61.79±14.90 years)was significantly higher than no WMA group(55.52±12.58 years),p=0.011.However,multifactorial analysis showed that age was not an independent factor for WMA in patients with AMI.The LVEF of WMA group(52.61±9.36%)was significantly lower than no WMA group(62.27±5.90%),p < 0.001,odds ratio(OR)0.841.The incidence of WMA in STEMI patients(82/103)was significantly higher than that in NSTEMI patients(45/72),p< 0.05,OR0.024.Multivariate analysis STEMI was independent factors of WMA in patients with AMI,WMA was obviously associated with LVEF,and were not affected by confounding factors such as onset time,age,sex,obesity and underlying diseases.ConclusionsEmergency point-of-care ultrasound has important diagnostic value for a variety of cardiovascular diseases,especially in the identification of MACE.It is recommended to routinely perform emergency point-of-care ultrasound for chest pain patients admitted to the emergency department with HEART score ≥4.Patients with a score of 4-5 can safely leave the hospital after negative ultrasound results,and patients with a score of ≥6 can make the next hospitalization treatment plan according to the ultrasound results.Emergency point-of-care echocardiography has high diagnostic efficacy from the onset of AMI,and WMA is a stable diagnostic marker.STEMI was an independent factor for WMA in patients with AMI,and WMA was independently associated with LVEF,suggesting that WMA might be associated with infarct severity and decreased ventricular systolic function. |
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