Key result
Fast-strain-encoded CMR with hyperventilation outperforms hscTnT dynamics for identifying ACS, achieving an AUC of ~0.84.
Why the study?
Patients with suspected ACS in the high-sensitivity cardiac troponin T observe zone after 1 h need further diagnostic testing, and fast-strain encoded CMR with breathing maneuvers may accelerate this work-up.
Does fast-strain-encoded CMR imaging with hyperventilation accurately identify acute coronary syndrome in patients with acute chest pain and inconclusive initial troponin T?
Observational (n=108)
Double-blind
No
Does fast-strain-encoded CMR imaging with hyperventilation accurately identify acute coronary syndrome in patients with acute chest pain and inconclusive initial troponin T?
Absolute Event Rate: 0.842% vs 0.625%
p-value: p=<0.0001
Fast-strain-encoded CMR imaging with hyperventilation provides a rapid, contrast-free, and stress-free method to accurately identify acute coronary syndrome in patients with inconclusive initial troponin T levels.
May support strain-encoded CMR for ACS detection with inconclusive troponin; leaves open randomized validation before practice change.
In patients with suspected acute coronary syndrome high-sensitivity cardiac tropnonin T is used for rapid patient triage. Some acute coronary syndrome patients assigned to the observe zone based on high-sensitivity cardiac troponin T after 1 h require further diagnostic testing. Fast-strain encoded CMR imaging with breathing maneuvers may accelerate diagnostic work-up and identify patients suffering from acute coronary syndrome. Patients presenting with acute chest pain (high-sensitivity cardiac troponin T level 5-52 ng/L) were prospectively enrolled (consecutive sampling, time of recruitment: 09/18-06/19). Fast-strain-encoded imaging was performed within the 1-h timeframe (0 h/1 h algorithm) prior to 2nd high-sensitivity troponin T lab results. Images were acquired at rest as well as after 1-min of hyperventilation followed by a short breath-hold. In 108 patients (59 male; mean age: 57 ± 17y) the mean study time was 17 ± 3 min. An abnormal strain response after the breathing maneuver (persistent/increased/new onset of increased strain rates) correctly identified all 17 patients with a high-sensitivity troponin T dynamic (0 h/1 h algorithm) and explanatory significant coronary lesions, while in 86 patients without serologic or angiographic evidence for severe coronary artery disease the strain response was normal (sensitivity 100%, specificity 94.5%; 5 false positive results). The number of dysfunctional segments (strain > - 10%) proved to be a quantifiable marker for identifying patients with acute coronary syndrome. In patients with suspected acute coronary syndrome and inconclusive initial high-sensitivity troponin T, fast-strain-encoded imaging with a breathing maneuver may safely and rapidly identify patients with acute coronary syndrome, without the need for vasodilators, stress, or contrast agents.
No takes yet. Share an insight, caveat, or question.
Siry et al. (2022) conducted an observational in Acute chest pain with suspected acute coronary syndrome (n=108). Fast-strain-encoded (fSENC) CMR imaging with hyperventilation breath-hold vs. High-sensitivity cardiac troponin T (hscTnT) dynamics (0 h/1 h algorithm) was evaluated on Diagnostic accuracy (AUC) for predicting ACS using number of dysfunctional segments after hyperventilation (95% CI 0.75-0.94, p=<0.0001). Fast-strain-encoded CMR imaging with a hyperventilation breath-hold maneuver accurately identified patients with acute coronary syndrome, achieving an AUC of 0.842 compared to 0.625 for hscTnT dynamics.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: