Chest pain evaluation in the emergency department

Can MDCT provide a comprehensive evaluation?

Charles S. White, Dick Kuo, Mark Kelemen, Vineet R. Jain, Amy Musk, Eram Zaidi, Katrina Read, Clint Sliker, Rajnish Prasad

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of our study was to determine whether MDCT can provide a comprehensive assessment of cardiac and noncardiac causes of chest pain in stable emergency department patients. SUBJECTS AND METHODS. Patients with chest pain who presented to the emergency department without definitive findings of acute myocardial infarction based on history, physical examination, and ECG were recruited immediately after the initial clinical assessment. For each patient, the emergency department physician was asked whether a CT scan would normally have been ordered on clinical grounds (e.g., to exclude pulmonary embolism). Each consenting patient underwent enhanced ECG-gated 16-MDCT. Ten cardiac phases were reconstructed. The images were evaluated for cardiac (coronary calcium and stenosis, ejection fraction, and wall motion and perfusion) and significant noncardiac (pulmonary embolism, dissection, pneumonia, and so forth) causes of chest pain. Correlation was made between the presence of significant cardiac and noncardiac findings on CT and the final clinical diagnosis based on history, examination, and any subsequent cardiac workup at the 1-month follow-up by a consensus of three physicians. RESULTS. Sixty-nine patients met all criteria for enrollment in the study, of whom 45 (65%) would not otherwise have undergone CT. Fifty-two patients (75%) had no significant CT findings and a final diagnosis of clinically insignificant chest pain. Thirteen patients (19%) had significant CT findings (cardiac, 10; noncardiac, 3) concordant with the final diagnosis. CT failed to suggest a diagnosis in two patients (3%), both of whom proved to have clinically significant coronary artery stenoses. In two patients (3%), CT overdiagnosed a coronary stenosis. Sensitivity and specificity for the establishment of a cardiac cause of chest pain were 83% and 96%, respectively. Overall sensitivity and specificity for all other cardiac and noncardiac causes were 87% and 96%, respectively. CONCLUSION. ECG-gated MDCT appears to be logistically feasible and shows promise as a comprehensive method for evaluating cardiac and noncardiac chest pain in stable emergency department patients. Further hardware and software improvements will be necessary for adoption of this paradigm in clinical practice.

Original languageEnglish (US)
Pages (from-to)533-540
Number of pages8
JournalAmerican Journal of Roentgenology
Volume185
Issue number2
StatePublished - 2005
Externally publishedYes

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Chest Pain
Hospital Emergency Service
Coronary Stenosis
Electrocardiography
Pulmonary Embolism
History
Physicians
Sensitivity and Specificity
Physical Examination
Dissection
Pneumonia
Software
Perfusion
Myocardial Infarction
Calcium

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

White, C. S., Kuo, D., Kelemen, M., Jain, V. R., Musk, A., Zaidi, E., ... Prasad, R. (2005). Chest pain evaluation in the emergency department: Can MDCT provide a comprehensive evaluation? American Journal of Roentgenology, 185(2), 533-540.

Chest pain evaluation in the emergency department : Can MDCT provide a comprehensive evaluation? / White, Charles S.; Kuo, Dick; Kelemen, Mark; Jain, Vineet R.; Musk, Amy; Zaidi, Eram; Read, Katrina; Sliker, Clint; Prasad, Rajnish.

In: American Journal of Roentgenology, Vol. 185, No. 2, 2005, p. 533-540.

Research output: Contribution to journalArticle

White, CS, Kuo, D, Kelemen, M, Jain, VR, Musk, A, Zaidi, E, Read, K, Sliker, C & Prasad, R 2005, 'Chest pain evaluation in the emergency department: Can MDCT provide a comprehensive evaluation?', American Journal of Roentgenology, vol. 185, no. 2, pp. 533-540.
White, Charles S. ; Kuo, Dick ; Kelemen, Mark ; Jain, Vineet R. ; Musk, Amy ; Zaidi, Eram ; Read, Katrina ; Sliker, Clint ; Prasad, Rajnish. / Chest pain evaluation in the emergency department : Can MDCT provide a comprehensive evaluation?. In: American Journal of Roentgenology. 2005 ; Vol. 185, No. 2. pp. 533-540.
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abstract = "OBJECTIVE. The purpose of our study was to determine whether MDCT can provide a comprehensive assessment of cardiac and noncardiac causes of chest pain in stable emergency department patients. SUBJECTS AND METHODS. Patients with chest pain who presented to the emergency department without definitive findings of acute myocardial infarction based on history, physical examination, and ECG were recruited immediately after the initial clinical assessment. For each patient, the emergency department physician was asked whether a CT scan would normally have been ordered on clinical grounds (e.g., to exclude pulmonary embolism). Each consenting patient underwent enhanced ECG-gated 16-MDCT. Ten cardiac phases were reconstructed. The images were evaluated for cardiac (coronary calcium and stenosis, ejection fraction, and wall motion and perfusion) and significant noncardiac (pulmonary embolism, dissection, pneumonia, and so forth) causes of chest pain. Correlation was made between the presence of significant cardiac and noncardiac findings on CT and the final clinical diagnosis based on history, examination, and any subsequent cardiac workup at the 1-month follow-up by a consensus of three physicians. RESULTS. Sixty-nine patients met all criteria for enrollment in the study, of whom 45 (65{\%}) would not otherwise have undergone CT. Fifty-two patients (75{\%}) had no significant CT findings and a final diagnosis of clinically insignificant chest pain. Thirteen patients (19{\%}) had significant CT findings (cardiac, 10; noncardiac, 3) concordant with the final diagnosis. CT failed to suggest a diagnosis in two patients (3{\%}), both of whom proved to have clinically significant coronary artery stenoses. In two patients (3{\%}), CT overdiagnosed a coronary stenosis. Sensitivity and specificity for the establishment of a cardiac cause of chest pain were 83{\%} and 96{\%}, respectively. Overall sensitivity and specificity for all other cardiac and noncardiac causes were 87{\%} and 96{\%}, respectively. CONCLUSION. ECG-gated MDCT appears to be logistically feasible and shows promise as a comprehensive method for evaluating cardiac and noncardiac chest pain in stable emergency department patients. Further hardware and software improvements will be necessary for adoption of this paradigm in clinical practice.",
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