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European Journal of Echocardiography Advance Access published online on February 7, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen005
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Published on behalf of the European Society of Cardiography. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Prognostic importance of tissue Doppler-derived diastolic function in patients presenting with acute coronary syndrome: a bedside echocardiographic study

Marjorie Richardson-Lobbedez1,{dagger}, Sylvestre Maréchaux1,{dagger}, Christophe Bauters2, Julie Darchis1, Jean Luc Auffray1, Jean Jacques Bauchart1, Jean Marc Aubert1, Thierry H. LeJemtel4, Martine Lesenne1, Eric Van Belle2, Patrick Goldstein3, Philippe Asseman2 and Pierre V. Ennezat1,*

1 Centre Hospitalier Régional et Universitaire de Lille, Intensive Care Unit, Lille F-59019, France
2 Université de Lille II, faculté de médecine, Lille F-59045, France
3 Centre Hospitalier Régional et Universitaire de Lille, Emergency Department, Lille F-59019, France
4 Division of Cardiology (THL), Tulane Medical School of Medicine, New Orleans, LA, USA

Received 4 August 2007; accepted after revision 28 October 2007.

* Corresponding author: Intensive Care Unit, Cardiology Hospital, Bd Pr J. Leclercq, 59000 Lille, France. Tel: +33 03 20 44 53 30; fax: +33 03 20 44 56 04. E-mail address: ennezat{at}yahoo.com


  Abstract

Aims: We sought to evaluate the prognostic value of bedside tissue Doppler derived diastolic function in patients presenting with acute coronary syndrome (ACS) on top of major clinical predictors of mortality and routine laboratory testings.

Methods and results: Bedside Doppler echocardiography and laboratory tests were prospectively performed in 239 consecutive patients (mean age 62 ± 14, 69% men) admitted for ACS. Ratio of early transmitral flow (E) to early mitral annulus velocities (e') was calculated. The study endpoint was cardiac death. The median follow-up period was 2 years. E/e' was >15 in 39 patients. Multivariate predictors of E/e' > 15 were older age, diabetes, non-ST-segment elevation ACS, and decreased LV ejection fraction (LVEF). Survival free from cardiac death was lower in patients with E/e' ratio >15 (P = 0.01). History of coronary artery disease, lower creatinine clearance, higher glycemia on admission, decreased LVEF, and E/e' >15 were independent predictors of cardiac death.

Conclusion: Bedside Doppler echocardiography provides prognostic information on top of major clinical predictors of mortality and routine laboratory testings in patients presenting with ACS.

Keywords: Tissue Doppler imaging; Acute coronary syndrome; Prognosis

{dagger} M. R.-L. and S. M. both contributed equally to the preparation of the manuscript.


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