Dobutamine stress tele-echocardiography for evaluation of emergency department patients with chest pain

Objectives. The practicality and accuracy of dobutamine stress tele-echocardiography (DSTE) mere assessed in patients presenting to the emergency department with chest pain. Background. Many patients evaluated for chest pain in the emergency department (ED) are admitted to the hospital needlessly because of the difficulty in differentiating noncardiac chest pain from myocardial ischemia. Methods. One hundred sixty-three patients with no evidence of myocardial infarction on initial blood studies or the electrocardiogram who were recommended for hospital admission to rule out myocardial infarction or myocardial ischemia were enrolled in this four-phase study. Rest echocardiography was performed in the ED, and the images were transmitted to a cardiologist for interpretation. If the results were normal, DSTE was then administered by a trained nurse. In the first three phases, all patients were admitted for observation regardless of the results of DSTE. In the fourth phase, those having normal DSTE results were able to be released. Results. The test was completed within an average of 5.4 h of presentation to the ED. The sensitivity and specificity of DSTE versus clinical and cardiac catheterization findings were 89.5% and 88.9%, respectively, with a negative predictive value for DSTE of 98.5%. Patients experienced frequent mild side effects (54.7%), but few (6.3%) caused the test to be discontinued prematurely. In phase 4 of the study, 72% of those slated for hospital admission because of cardiac risk factors and chest pain suggesting myocardial ischemia mere discharged after normal DSTE results. Conclusions. The use of DSTE in the evaluation of patients presenting with chest pain may improve screening for those who can be safely released from the ED. (C) 1997 by the American College of Cardiology.