Role of Stress Echocardiography with or without contrast in ACS patients

Coronary artery disease is a major cause of mortality and morbidity in many countries. Chest pain is the major, common problem in Emergency Departments. Patients with chest pain have a spectrum of cardiac risk including typical chest pain with typical ECG findings compatible with ACS who should be referred to cath lab as soon as possible. At the other end of spectrum are patients with atypical chest pain ,and nonspecific ECG changes who need to stablished a Rule in Or Rule Out diagnosis. Most of these patients admitted to hospital because of uncertain DX.In face of clinical uncertainty Imaging study with stress echocardiography with or without contrast injection could be a great opportunity to provide a cost-effective solution in terms of both diagnosis and prognosis in these patients.Echocardiography has the advantage of real time, cheap and free of radiation (using ionizing contrast), so is the method of choice to evaluate both anatomic and functional evidence of ischemia.Assessing of inducible ischemia during pharmacologic or nonpharmacologic provocative test in ED is feasible and reliable. Also contrast introducing during test could be the best approach for better evaluation of endocardial border delineation and myocardial perfusion to increase accuracy and specificity of test.