The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis
Abstract Background Chest pain is responsible for millions of visits to the emergency department (ED) annually. Cardiac ultrasound can detect ischemic changes, but varying accuracy estimates have been reported in previous studies. We synthetized the available evidence to yield more precise estimates...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-024-01192-3 |
| _version_ | 1827315784640102400 |
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| author | Virginia Zarama María Camila Arango-Granados Ramiro Manzano-Nunez James P. Sheppard Nia Roberts Annette Plüddemann |
| author_facet | Virginia Zarama María Camila Arango-Granados Ramiro Manzano-Nunez James P. Sheppard Nia Roberts Annette Plüddemann |
| author_sort | Virginia Zarama |
| collection | DOAJ |
| description | Abstract Background Chest pain is responsible for millions of visits to the emergency department (ED) annually. Cardiac ultrasound can detect ischemic changes, but varying accuracy estimates have been reported in previous studies. We synthetized the available evidence to yield more precise estimates of the accuracy of cardiac ultrasound for acute myocardial ischemia in patients with chest pain in the ED and to assess the effect of different clinical characteristics on test accuracy. Methods A systematic search for studies assessing the diagnostic accuracy of cardiac ultrasound for myocardial ischemia in the ED was conducted in MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Web of Science, two trial registries and supplementary methods, from inception to December 6th, 2022. Prospective cohort, cross-sectional, case–control studies and randomized controlled trials (RCTs) that included data on diagnostic accuracy were included. Risk of bias was assessed with the QUADAS-2 tool and a bivariate hierarchical model was used for meta-analysis with paired Forest and SROC plots used to present the results. Subgroup analyses was conducted on clinically relevant factors. Results Twenty-nine studies were included, with 5043 patients. The overall summary sensitivity was 79.3% (95%CI 69.0–86.8%) and specificity was 87.3% (95%CI 79.9–92.2%), with substantial heterogeneity. Subgroup analyses showed increased sensitivity in studies where ultrasound was conducted at ED admission and increased specificity in studies that excluded patients with previous heart disease, when the target condition was acute coronary syndrome, or when final chart review was used as the reference standard. There was very low certainty in the results based on serious risk of bias and indirectness in most studies. Conclusions Cardiac ultrasound may have a potential role in the diagnostic pathway of myocardial ischemia in the ED; however, a pooled accuracy must be interpreted cautiously given substantial heterogeneity and that important patient and test characteristics affect its diagnostic performance. Protocol Registration: PROSPERO (CRD42023392058). |
| first_indexed | 2024-04-24T23:04:14Z |
| format | Article |
| id | doaj.art-e584ec9cadcf4a779c6f2d39b57fa593 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-04-24T23:04:14Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-e584ec9cadcf4a779c6f2d39b57fa5932024-03-17T12:36:32ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412024-03-0132111610.1186/s13049-024-01192-3The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysisVirginia Zarama0María Camila Arango-Granados1Ramiro Manzano-Nunez2James P. Sheppard3Nia Roberts4Annette Plüddemann5Facultad de Ciencias de la Salud, Universidad ICESIFacultad de Ciencias de la Salud, Universidad ICESIClinical Research Unit, Hospital del Mar Research InstituteCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of OxfordBodleian Health Care Libraries, University of OxfordCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of OxfordAbstract Background Chest pain is responsible for millions of visits to the emergency department (ED) annually. Cardiac ultrasound can detect ischemic changes, but varying accuracy estimates have been reported in previous studies. We synthetized the available evidence to yield more precise estimates of the accuracy of cardiac ultrasound for acute myocardial ischemia in patients with chest pain in the ED and to assess the effect of different clinical characteristics on test accuracy. Methods A systematic search for studies assessing the diagnostic accuracy of cardiac ultrasound for myocardial ischemia in the ED was conducted in MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Web of Science, two trial registries and supplementary methods, from inception to December 6th, 2022. Prospective cohort, cross-sectional, case–control studies and randomized controlled trials (RCTs) that included data on diagnostic accuracy were included. Risk of bias was assessed with the QUADAS-2 tool and a bivariate hierarchical model was used for meta-analysis with paired Forest and SROC plots used to present the results. Subgroup analyses was conducted on clinically relevant factors. Results Twenty-nine studies were included, with 5043 patients. The overall summary sensitivity was 79.3% (95%CI 69.0–86.8%) and specificity was 87.3% (95%CI 79.9–92.2%), with substantial heterogeneity. Subgroup analyses showed increased sensitivity in studies where ultrasound was conducted at ED admission and increased specificity in studies that excluded patients with previous heart disease, when the target condition was acute coronary syndrome, or when final chart review was used as the reference standard. There was very low certainty in the results based on serious risk of bias and indirectness in most studies. Conclusions Cardiac ultrasound may have a potential role in the diagnostic pathway of myocardial ischemia in the ED; however, a pooled accuracy must be interpreted cautiously given substantial heterogeneity and that important patient and test characteristics affect its diagnostic performance. Protocol Registration: PROSPERO (CRD42023392058).https://doi.org/10.1186/s13049-024-01192-3EchocardiographyEmergency departmentIschemiaMyocardial infarctionPOCUSPoint-of-care |
| spellingShingle | Virginia Zarama María Camila Arango-Granados Ramiro Manzano-Nunez James P. Sheppard Nia Roberts Annette Plüddemann The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Echocardiography Emergency department Ischemia Myocardial infarction POCUS Point-of-care |
| title | The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis |
| title_full | The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis |
| title_fullStr | The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis |
| title_full_unstemmed | The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis |
| title_short | The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis |
| title_sort | diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department a systematic review and meta analysis |
| topic | Echocardiography Emergency department Ischemia Myocardial infarction POCUS Point-of-care |
| url | https://doi.org/10.1186/s13049-024-01192-3 |
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