Patients with myocardial infarction require invasive treatment involving coronary angiography to confirm the diagnosis and, in most cases, treatment by angioplasty/stenting. Trans-thoracic ultrasound is central to the initial management of patients admitted to hospital with acute coronary syndrome without ST segment elevation.
The aim of our study is therefore to compare perfusion ultrasound with coronary angiography and MRI in this population in order to determine whether the performance is satisfactory.
Patient over 18 years of age
Hospitalised in cardiology as an emergency for acute coronary syndrome without ST segment elevation with indication for coronary angiography within 72 hours of admission
Not yet undergone coronary angiography.
Troponin >99th percentile, i.e. >27ng/l (troponin I, hypersensitive, Abbott)
Rhythmically unstable patient: sustained ventricular tachycardia, sudden death recovered.
Patient with a known allergy to ultrasound contrast medium
Patient with ST segment elevation.
Patient with a contraindication to MRI.
Single group
perfusion ultrasound
Other interventionDuring the examination, the power of the probe will be increased in order to assess myocardial perfusion. The contrast agent bubbles are destroyed by applying a 'flash', i.e. a temporary increase in the power of the ultrasound beam. Systole after systole, on a recorded loop, the filling velocity of the myocardium, which depends on myocardial blood flow, is analysed. The assessment of perfusion is visual and qualitative.
Sensitivity (SE) and specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) (diagnosis obtained by consensus of two cardiologists based on all blinded examinations of the ultrasound results).
Contrast-enhanced ultrasound (same measurements) according to recommendations, performed and interpreted by cardiologist 1, then reviewed and reinterpreted by the cardiologist. The reference diagnosis will be established by two cardiologists. The two cardiologists will therefore work blind to the examination being evaluated.
Concordance between the diagnosis of TET from perfusion and the 'gold standard' (diagnosis obtained by consensus of two cardiologists based on all blinded examinations of the echo results). Kappa coefficient
The two cardiologists will each give their diagnosis independently. If there's a disagreement between them, a third cardiologist (cardiologist number 5) will be called in to help, and the final decision will be made by majority vote. The two cardiologists will therefore work blind to the test being evaluated.
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