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Clinical Value of Mesuron's MagnetoCardioGraphy for Emergency Medicine - ER, ED and Chest Pain Units

 

 

Mesuron’s MagnetoCardioGraph is the only reasonable Solution for

Managing Acute Chest Pain Patients in Emergency Departments!

 

Chest pain accounts for approximately 7 million annual visits to emergency departments (ED) in the United States, making chest pain the second most common complaint [1]. 

Chest Pain Patients (CPP) present with a spectrum of signs and symptoms reflecting the many potential etiologies of chest pain. Diseases of the heart, aorta, lungs, esophagus, stomach, mediastinum, pleura, and abdominal viscera may all cause chest discomfort. Non-cardiac chest pain (NCCP) is very common in the general population [2]. 75% CPP patients will have a non-cardiac condition, however most of these will still follow the chest pain pathway and undergo serial cardiac biomarker testing to rule out an MI or other cardiac syndromes [3]. When it comes to chest pain, the cardiologist's first priority is to exclude any acute life-threatening cardiovascular condition [3]. These include acute coronary syndrome, aortic dissection, pulmonary thromboembolism, and pericardial tamponade. If these acute conditions have been excluded, evaluation for chronic ischemic heart disease or pericardial disease must be pursued [2].

 Patient outcome has not been ideal for the majority of patients who experience delays in the emergency department (ED) before receiving definitive therapy. Furthermore, a significant number of patients with AMI (4% to 13%) are not diagnosed by the emergency physician [1-3]. These AMI patients, once inadvertently released home, have 11% to 25% risk of dying from the MI [2,3]. These patients are the most expensive cause of malpractice litigation against emergency physicians, comprising 20% of dollars paid for malpractice. - See more at: http://www.acep.org/Clinical---Practice-Management/Chest-Pain-Units-in-Emergency-Departments/#sthash.JZbl4W4s.dPaM5XFi.dpuf

If a patient with an AMI is treated within 70 minutes, the left ventricular damage can be minimized due to infarct abortion, and mortality decreases to 1.6% [8]. If therapy is delivered after this time, mortality and morbidity from AMI rise dramatically, as significant irreversible myocardial damage has already occurred. - See more at: http://www.acep.org/Clinical---Practice-Management/Chest-Pain-Units-in-Emergency-Departments/#sthash.JZbl4W4s.dPaM5XFi.dpuf

There is a need in technology for ER and ED medicine that delivers results during minutes after patient admission, that could rule out patients with high and low risks cardiac event correspondingly with high negative and positive prediction values. According the references above, there is a demand of Emergency Medicine delivering test results such as SPECT does during the minutes but not hours. In fact, MCG is exactly what is needed. According the study provided by Cedar Sinai Medical Center [4], MCG data taken from the chest pain patients can deliver the similar result or better than SPECT in diagnostics of ischemic heart disease. Available MCG data was provided by an MCG system that took about 6-8 minutes of measurements (now reduced to 1 – 1.5 minutes in the new system), delivering analysis during next 3-5 minutes. Even though results were very promising, there were problems with system performance in close proximity of elevators, moving hospital personnel and activities in nearby rooms, creating a serious difficulty in using MCG in ER, ED or ICU departments.

Also those systems, requiring Liquid Helium, had to be refilled twice a week.  Mesuron Inc. has developed sophisticated MCG system and software configuration that solved those problems completely. This new system operates without using the liquid helium (cooling provided by a cryocooler coupled with proprietary Mesuron technology that allows very effective removal of heat from the cooled volume -- another significant advantage unique to our system). Mesuron MCG system allows measuring the heart signal  in real hospital environment in close proximity to all kinds of machinery, freight elevators, working printers, computers and moving hospital personnel.

Mesuron MCG system such as“Avalon-90” can deliver heart Ventricle Repolarization Dynamics Analysis (VRDA) during 3-5 minutes; that includes taking the cardiac data during only 90 seconds or less. The result of the VRDA is similar to what SPECT does. The reason for this similarity is clear: hypoxia of some region of the heart muscles manifests itself in both diagnostics. SPECT detects the regions of the heart with hypoxia (reduced delivery of blood supply) using the radioactive chemical containing Thallium that acts similar to oxygen. Scanning the heart, SPECT can identify regions of the heart with insufficient Thallium supply in heart muscles affected by insufficient blood supply.

MCG VRDA analysis detects the multidimensional dynamics of the electrical activity caused by differences in functions of Electrical Action Potential EAP of normal heart tissues and abnormal ones, with hypoxia. Interaction of functions of EAP of normal and affected regions is creating the repolarization dynamics that is different from the normal repolarization of the heart muscles activity. Mesuron’s MCG VRDA can detect repolarization problem even without hypoxia event per say. EAP of heart muscles experienced with insufficient blood supply during prolong time also has different function due to changes in chemistry of muscles activities adapting insufficient blood supply. As a result, the MCG can detect abnormalities even with no presence of hypoxia at the time of measurements. That is why MCG results in CSMC study were so similar to SPECT, even when taking the MCG data on patients at rest.

Conclusion: MCG VRDA is a rapid noninvasive, no radiation, no contact, no pharmaceuticals, no physical exercise test delivering results with indications of high risk and low risk cardiac patients (related to ventricle repolarization abnormalities) with high positive and negative predictive values.

References:

 

1.  Richard Niska, M.D., M.P.H., F.A.C.E.P.; Farida Bhuiya, M.P.H.; and Jianmin Xu, M.S.; Division of Health Care Statistics,

National Health Statistics Report #26 August 5, 2010

2.  http://www.uptodate.com/contents/evaluation-of-the-adult-with-chest-pain-in-the-emergency-department

3.  Ronnie Fass1 and Sami R Achem Noncardiac Chest Pain: Epidemiology, Natural Course and Pathogenesis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093002/

4.  Backus et al. 2011; Rohacek et al. 2012; Six et al. 2012; Backus et al. 2013

5.  Kirsten Tolstrup, Bo E. Madsen, Jose A. Ruiz, Stephen D. Greenwood, Judeen Camacho, Robert J. Siegel, H. Caroline Gertzen, Jai-Wung Park, Peter A. Smars "Non - Invasive Resting Magnetocardiographic Imaging for the Rapid Detection of Ischemia in Subjects Presenting with Chest Pain" Cardiology 2006; 106:270-276 Read PDF file here    Read Online here

 

Bibliography for Chest Pain Patients:

 

 

1.  Richard Niska, M.D., M.P.H., F.A.C.E.P.; Farida Bhuiya, M.P.H.; and Jianmin Xu, M.S.; Division of Health Care Statistics, National Health Statistics Report #26 August 5, 2010

2.  McCaig, L, Burt, C. National Hospital Ambulatory Medical Care Survey: 2003 Emergency Department Summary. In: Advance Data from Vital and Health Statistics. Centers for disease control and prevention, Atlanta, GA 2005.

3.  Launbjerg J, Fruergaard P, Hesse B, et al. Long-term risk of death, cardiac events and recurrent chest pain in patients with acute chest pain of different origin. Cardiology 1996; 87:60.

4.  Lindsell CJ, Anantharaman V, Diercks D, et al. The Internet Tracking Registry of Acute Coronary Syndromes (i*trACS): a multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies. Ann Emerg Med 2006; 48:666.

5.  Estrera AS, Landay MJ, Grisham JM, et al. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983; 157:545.

6.  Burnett CM, Rosemurgy AS, Pfeiffer EA. Life-threatening acute posterior mediastinitis due to esophageal perforation. Ann Thorac Surg 1990; 49:979.

7.  Sancho LM, Minamoto H, Fernandez A, et al. Descending necrotizing mediastinitis: a retrospective surgical experience. Eur J Cardiothorac Surg 1999; 16:200.

8.  Makeieff M, Gresillon N, Berthet JP, et al. Management of descending necrotizing mediastinitis. Laryngoscope 2004; 114:772.

9.  Gupta M, Tabas JA, Kohn MA. Presenting complaint among patients with myocardial infarction who present to an urban, public hospital emergency department. Ann Emerg Med 2002; 40:180.

10. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000; 342:1163.

11. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic   Dissection (IRAD): new insights into an old disease. JAMA 2000; 283:897.

12. Ringstrom E, Freedman J. Approach to undifferentiated chest pain in the emergency department: a review of recent medical literature and published practice guidelines. Mt Sinai J Med 2006; 73:499.

13. Jagminas L, Silverman RA. Boerhaave's syndrome presenting with abdominal pain and right hydropneumothorax. Am J Emerg Med 1996; 14:53.

14. Brauer RB, Liebermann-Meffert D, Stein HJ, et al. Boerhaave's syndrome: analysis of the literature and report of 18 new cases. Dis Esophagus 1997; 10:64.

15. Shry EA, Dacus J, Van De Graaff E, et al. Usefulness of the response to sublingual nitroglycerin as a predictor of ischemic chest pain in the emergency department. Am J Cardiol 2002; 90:1264.

16. Grailey K, Glasziou PP. Diagnostic accuracy of nitroglycerine as a 'test of treatment' for cardiac chest pain: a systematic review. Emerg Med J 2012; 29:173.

17. Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA 2002; 287:2262.

18. Goodacre S, Locker T, Morris F, Campbell S. How useful are clinical features in the diagnosis of acute, undifferentiated chest pain? Acad Emerg Med 2002; 9:203.

19. Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest 2002; 122:311.

20. Jayes RL Jr, Beshansky JR, D'Agostino RB, Selker HP. Do patients' coronary risk factor reports predict acute cardiac ischemia in the emergency department? A multicenter study. J Clin Epidemiol 1992; 45:621.

21. Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 1996; 100:164.

22. Henry M, Arnold T, Harvey J, Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003; 58 Suppl 2:ii39.

23. Papanicolaou MN, Califf RM, Hlatky MA, et al. Prognostic implications of angiographically normal and insignificantly narrowed coronary arteries. Am J Cardiol 1986; 58:1181.

24. Pitts WR, Lange RA, Cigarroa JE, Hillis LD. Repeat coronary angiography in patients with chest pain and previously normal coronary angiogram. Am J Cardiol 1997; 80:1086.

25. Brush JE Jr, Brand DA, Acampora D, et al. Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction. N Engl J Med 1985; 312:1137.

26. Slater DK, Hlatky MA, Mark DB, et al. Outcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings. Am J Cardiol 1987; 60:766.

27. Lee TH, Cook EF, Weisberg M, et al. Acute chest pain in the emergency room. Identification and examination of low-risk patients. Arch Intern Med 1985; 145:65.

28. Selker HP, Zalenski RJ, Antman EM, et al. An evaluation of technologies for identifying acute cardiac ischemia in the emergency department: a report from a National Heart Attack Alert Program Working Group. Ann Emerg Med 1997; 29:13.

29. Hathaway WR, Peterson ED, Wagner GS, et al. Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries. JAMA 1998; 279:387.

30. Rodger M, Makropoulos D, Turek M, et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 2000; 86:807.

31. Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347:161.

32. von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med 2000; 160:2977.

33. Ayaram D, Bellolio MF, Murad MH, et al. Triple rule out computed tomographic angiography for chest pain: a diagnostic systematic review and meta-analysis. Acad Emerg Med 2013; In Press.

34. Chase M, Robey JL, Zogby KE, et al. Prospective validation of the Thrombolysis in Myocardial Infarction Risk Score in the emergency department chest pain population. Ann Emerg Med 2006; 48:252.

35. Lee B, Chang AM, Matsuura AC, et al. Comparison of cardiac risk scores in ED patients with potential acute coronary syndrome. Crit Pathw Cardiol 2011; 10:64.

36. Meyer MC, Mooney RP, Sekera AK. A critical pathway for patients with acute chest pain and low risk for short-term adverse cardiac events: role of outpatient stress testing. Ann Emerg Med 2006; 47:427.

37. Walker NJ, Sites FD, Shofer FS, Hollander JE. Characteristics and outcomes of young adults who present to the emergency department with chest pain. Acad Emerg Med 2001; 8:703.

 

 

 

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