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The aim of the study is to find out the benefit of echocardiography, which is performed by a physican without a cardiological or radiological specialty. In this case the echocardiography is used in the first contact with a patient with chest pain of unclear etiology. Possible benefit is rapid risk stratification of acute non-stemi coronary syndromes and differentiation from other serious conditions, such as pulmonary embolism or aortic dissection.
Emergent echocardiography is reproducible method providing clinically significant information during primary survey of acute cardiovascular diseases. Possible benefit is the risk stratification of acute non-stemi coronary syndromes and differentiation from other serious conditions, such as pulmonary embolism or aortic dissection.
Step one - Education in Cardiac ultrasound. All physicians involved in ENDEMIC study have to undergo education program of heart ultrasonography. This curriculum fulfills BSE level one requirements. Candidates of this program have to make a defined number of ECHOcardiography studies under supervisor control. Every curriculum is finished by exam.
Step two - FOCUS in clinical practise Patients with chest pain are randomized into two groups by the even-odd rule.
Inclusion Criteria:
Chest pain ( Cardiovascular ethiology possible depends on anamnesis, physical examination and ECG ) Higher age than 18
Exclusion Criteria:
STEMI Pacemaker / ICD Pregnancy Performance status 4 ( Zubrod scale ) Informed Consent unsigned Prisoners
Step Three - Evaluation
Aims.:
Compare time to make a decision in these groups Compare time of stay at emergency department in these groups Compare time to invasive coronary angiography and revascularization (if available) Compare time to hospital dimission Occurrence of MACE in following 30 days
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FOCUS group | Experimental | Group of patients with chest pain undergoing FOCUS ( Focused Cardiac Ultrasound ). Patients with odd registration number. |
|
| Non-FOCUS group | Active Comparator | Patients with even registration number. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ECHOcardiography, Point-of-Care UZ | Device | Emergent echocardiography is reproducible method providing clinically significant information during primary survey of acute cardiovascular diseases. Possible benefit is the risk stratification of acute non-stemi coronary syndromes and differentiation from other serious conditions, such as pulmonary embolism or aortic dissection. The aim of interest is to consider riscs and benefits of the ultrasound of heart done by non-cardiologist after standardized course. |
| Measure | Description | Time Frame |
|---|---|---|
| Time of patient stay at Emergency Department | Time from initial contact with patient to patient discharge or hospital admission (minutes) | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Time of stay at hospital | Time from hospital admission to hospital discharge (hours) | 28 days |
| Major adverse cardiovascular events | Major adverse cardiovascular events are defined as composite endpoint of cardiovascular death, nonfatal myocardial infarction or unscheduled hospitalization due to cardiovascular disease (percent of patients in study groups). |
| Measure | Description | Time Frame |
|---|---|---|
| Time to Coronary Angiography | Time from initial contact to coronary angiography (days) | 365 days |
| Accuracy of thoracic ultrasound exam provided by non-cardiologist | All echocardiography records will be revised by skilled echocardiographist to assess the accuracy of performed examinations. All missed or erroneous finding resulting in alteration of patient management (especially wall motion abnormity, valvular disease and pericardial effusion) will be calculated. (quantity of erroneous or missed findings per record) |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Petr Grenar, MD | Contact | +420724027318 | petr.grenar@fnhk.cz | |
| Martin Jakl, assoc.prof. | Contact | +420607514962 | martin.jakl@fnhk.cz |
| Name | Affiliation | Role |
|---|---|---|
| Martin Jakl, assoc.prof. | University of Defense, Faculty of Military Health Sciences, Czech Republic | Study Director |
| Petr Grenar, MD | University of Defense, Faculty of Military Health Sciences, Czech Republic |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41284127 | Derived | Grenar P, Jakl M, Medilek K, Novy J, Koci J, Vanek J, Cermakova M, Horacek JM, Pudil R. Effect of point-of-care echocardiography by noncardiologists on patient management in acute chest pain. Intern Emerg Med. 2025 Nov 24. doi: 10.1007/s11739-025-04198-6. Online ahead of print. | |
| 38222095 | Derived | Grenar P, Novy J, Medilek K, Jakl M. Point-of-Care Cardiac Ultrasound Training Programme: Experience from the University Hospital Hradec Kralove. Emerg Med Int. 2024 Jan 6;2024:9974284. doi: 10.1155/2024/9974284. eCollection 2024. |
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To be shared:
Available 1 year after completing the study, for at least 10 years
Contact principal investigator
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| ID | Term |
|---|---|
| D054058 | Acute Coronary Syndrome |
| ID | Term |
|---|---|
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
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| ID | Term |
|---|---|
| D004452 | Echocardiography |
| ID | Term |
|---|---|
| D057791 | Cardiac Imaging Techniques |
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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|
| 30 days |
| 30 days |
| D014463 | Ultrasonography |
| D006334 | Heart Function Tests |
| D003935 | Diagnostic Techniques, Cardiovascular |