Evaluation of the effectiveness of achilles tendon thickness measured by bedside ultrasonography in predicting coronary artery involvement and adverse cardiac events in patients presenting to the emergency department with chest pain

AIM: This study aimed to investigate the relationship between achilles tendon thickness measured by bedside ultrasonography (USG) and acute coronary syndrome (ACS), risk scores, coronary artery involvement, and the development of major adverse cardiac events in patients presenting to the emergency department with chest pain. The hypothesis that achilles tendon thickness could serve as an independent marker in cardiovascular risk assessment in addition to traditional scoring systems was evaluated. MATERIALS AND METHODS: This prospective, randomized, observational study included 132 volunteer patients who presented to the Emergency Medicine Clinic of Sakarya University Training and Research Hospital between September 2024 and May 2025. Demographic data, comorbidities, ECG findings, laboratory values, and risk scores of the participants were recorded. Achilles tendon measurements were performed using a Butterfly iQ USG probe with biplane imaging. Patients were divided into groups with and without ACS, and coronary angiography results and 30-day major adverse cardiac events incidence were followed. RESULTS: In patients with ST-T segment changes on the ECG and those who were hospitalized, achilles tendon thickness and area measurements were found to be significantly higher statistically (p<0.05). A threshold value of 4.95 mm for thickness showed a sensitivity of 61-65% and a specificity of 60-64% for the hospitalization decision in patient outcomes. In patients classified as high-risk according to risk scoring, the achilles tendon was found to be significantly thicker statistically (p<0.05). However, no statistically significant difference was found between the measurements in groups with detected vascular pathology or those who developed major adverse cardiac events (p>0.05). CONCLUSİON: These findings suggest that Achilles tendon thickness may be associated with ST-T segment changes on ECG and hospitalization decisions in patients presenting with chest pain and that patients with thicker tendons may indicate higher cardiovascular risk. However, thickness was not found to be an independent predictor of the number of coronary artery lesions or the occurrence of major adverse cardiac events within 30 days. More comprehensive and long-term studies are needed to clarify the potential role of achilles tendon thickness in cardiovascular risk assessment. Keywords: Achilles tendon, ACS, chest pain, emergency department, USG