Usefulness of limited echocardiography with A-F mnemonic in patients with suspected non‑ST-segment elevation acute coronary syndrome

INTRODUCTION When diagnosing the causes of acute chest pain, both acute coronary syndromes (ACSs) and other serious conditions should be considered.

OBJECTIVES The aim of the study was to assess the usefulness of limited transthoracic echocardiography (TTE) with an A-F mnemonic in patients with suspected non-ST-segement elevation ACS (NSTE-ACS) and the effect of TTE on therapeutic decisions. 

PATIENTS AND METHODS This retrospective study was conducted at an emergency department for 12 months. The study population consisted of consecutive patients with a preliminary diagnosis of NSTE-ACS. We analyzed demographic data, clinical condition, medical history, electrocardiography, TTE, and the levels of necrotic markers. TTE with the A-F mnemonic was performed within 15 minutes from admission.

RESULTS A total of 916 consecutive patients were enrolled to the study. The diagnosis of ACS was confirmed in 70.19% of the patients. TTE with the A-F mnemonic revealed regional wall motion abnormalities in 74.03% of the ACS group and significant echocardiographic abnormalities in 2.18% of the ACS group and 55.31% of patients without ACS. On the basis of those findings, 4.69% of the patients underwent invasive treatment other than myocardial revascularization. A comparative analysis revealed that patients with ACS were older, more likely to have ST-segment depression, higher levels of necrotic markers, and lower left ventricular ejection fraction, while patients without ACS had more echocardiographic abnormalities in points B-F according to the A-F scheme.

CONCLUSIONS Limited TTE with the A-F mnemonic should be performed in all patients with suspected NSTE-ACS. It allows to confirm ischemia and detect other life-threatening conditions. TTE with the A-F mnemonic covers a sufficient spectrum of cardiac abnormalities and has a significant effect on therapeutic decision making in patients with suspected NSTE-ACS.