Abstract 2213: Cardiac-Chest Ultrasound Risk Score in Acute Coronary Syndromes: The Prognostic Value of the Echographic Deadly Quartet
Risk stratification in patients with acute coronary syndrome (ACS) is quintessential to identify high risk patients whose prognosis can be improved by appropriate treatment, and is achieved today by clinical models, such as Global Registry in Acute Events (GRACE) score, “blind” to the prognostic support of imaging methods. To assess the relative value of simple resting cardiac-chest sonography for risk stratification in ACS. We enrolled 203 consecutive in-patients (147 males, age 70±13 ys) admitted for ACS (77 STEMI, 73 NSTEMI, 53 unstable angina). On admission, all received a clinical score with GRACE and, within 1 to 12 hours, a comprehensive cardiac-chest ultrasound scan, including evaluation of Ultrasound Lung Comets (ULCs, an index of extravascular lung water), Ejection Fraction (EF), mitral regurgitation (MR), diastolic dysfunction, TAPSE (tricuspid annular plane systolic excursion) and PASP (Pulmonary Artery Systolic Pressure). Each parameter was scored from 0= normal, to 3=severely abnormal. Patients with intra-hospital events (n=81) could be separated from patients without events (n=112) on the basis of GRACE and by several echo parameters (see table⇓). Echo score generated by the 4 significant echo variables (EF, MR, diastolic dysfunction, ULCs) was more effective if performed on admission (n=50, p<.001), than within 12 hours (n=153, p<.049). In ACS, an effective risk stratification can be achieved the prognostic ultrasound “deadly quartet”: EF, MR, ULCs and restrictive pattern. The timing of imaging also matters: the earlier the echo imaging, the better the prognostic capability.