WAMAMI: emergency physicians can accurately identify wall motion abnormalities in acute myocardial infarction

Am J Emerg Med. 2019 Dec;37(12):2224-2228. doi: 10.1016/j.ajem.2019.03.037. Epub 2019 Apr 3.


Objective: The ability to identify wall motion abnormalities may be useful for emergency clinicians, but is not typically evaluated in point-of-care echocardiograms. We sought to determine if emergency physicians with basic training in emergency echocardiography could identify regional wall motion abnormalities (RWMA) in patients admitted with ST-elevation myocardial infarction (STEMI).

Methods: We prospectively enrolled patients with admitted with STEMI. Resident physicians with basic training in emergency ultrasound, blinded to other patient data, performed a point-of-care echocardiogram to evaluate for RWMA. If present, they also recorded the suspected territory of the RWMA. We calculated test performance characteristics and compared the agreement between point-of-care and comprehensive echocardiogram for RWMA and territory.

Results: 75 patients with STEMI were enrolled, and 62% had a RMWA. RWMA were identified with excellent test performance characteristics (sensitivity 88% (95% CI 75-96); specificity 92% (95% CI 75-99)). There was substantial agreement between the point-of-care echocardiogram and reference standard (K = 0.79; 95% CI: 0.64-0.94).

Conclusions: Emergency physicians with core training in point-of-care echocardiography can accurately identify RMWA.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chest Pain / diagnostic imaging*
  • Echocardiography / standards*
  • Emergency Medicine / education*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Internship and Residency
  • Male
  • Middle Aged
  • Point-of-Care Testing*
  • Predictive Value of Tests
  • Prospective Studies
  • ST Elevation Myocardial Infarction / diagnosis*
  • Single-Blind Method