The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis

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• dc.contributor.author Zarama, Virginia
• dc.contributor.author Arango-Granados, María Camila
• dc.contributor.author Manzano-Nuñez, Ramiro
• dc.contributor.author Sheppard, James P.
• dc.contributor.author Roberts, Nia
• dc.contributor.author Plüddemann, Annette
• dc.date.accessioned 2025-07-16T07:34:37Z
• dc.date.available 2025-07-16T07:34:37Z
• dc.date.issued 2024
• dc.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).
• dc.format.mimetype application/pdf
• dc.identifier.citation Zarama V, Arango-Granados MC, Manzano-Nunez R, Sheppard JP, Roberts N, Plüddemann A. The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2024 Mar 11;32(1):19. DOI: 10.1186/s13049-024-01192-3
• dc.identifier.doi http://dx.doi.org/10.1186/s13049-024-01192-3
• dc.identifier.issn 1757-7241
• dc.identifier.uri http://hdl.handle.net/10230/70931
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof Scand J Trauma Resusc Emerg Med. 2024 Mar 11;32(1):19
• dc.rights © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Echocardiography
• dc.subject.keyword Emergency department
• dc.subject.keyword Ischemia
• dc.subject.keyword Myocardial infarction
• dc.subject.keyword POCUS
• dc.subject.keyword Point-of-care
• dc.subject.keyword Ultrasound
• dc.title The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion