To evaluate diagnostic role of echocardiography in the patients of acute chest pain with nonspecific ECG findings we have performed prospective study.

79 out of 101 consecutive patients presenting to the emergency room with symtoms suggestive of acute coronary syndrome (ACS) without diagnostic ECG change were studied. Presence and score of regional wall motion abnormality (RWMA) were assessed according to the American Society of Echocardiography guideline (16 segment model) by two-dimensional echocardiography within 4 hours after arrival. The diagnosis of acute myocardial infarction (AMI) was confirmed by serial myocardial enzyme assay retrospectively.

Of the 28 patients with RWMA, 13 (46%) had non-Q AMI, 8 (28%) had unstable angina, 3 (11%) had posterior AMI. Of the 51 patients with normal wall motion, 10 had gastroesophageal disease, 9 had variant angina, 3 had psychologic disease, 1 had aortic dissection and 1 had hypertrophic cardiomyopathy. Thus, Presence of RWMA by echocardiography had a sensitivity of 49% and a specificity of 88% for diagnosis of ACS. In 21 ACS patients with RWMA, regional wall motion score was significantly higher in AMI than in unstable angina (3.1±1.8 vs 1.0±2.2, p<0.05). As for the significant coronary artery stenosis, there was a higher incidence of multivessel disease in the patients with RWMA (64%).

RWMA by two-dimensional echocardiography in the emergency room is not a sensitive but a specific technique to diagnose ACS patient with nonspecific ECG change, especially in posterior AMI and non-Q AMI.