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European Journal of Echocardiography 2004 5(2):142-148; doi:10.1016/S1525-2167(03)00077-5
© 2004 by European Society of Cardiology
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Copyright © 2003, The European Society of Cardiology

Wall thickening assessment with tissue harmonic echocardiography results in improved risk stratification for patients with non-ST-segment elevation acute chest pain

M. Hickman, J.M.A. Swinburn and R. Senior*

Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK

Received 6 March 2003; received in revised form 17 July 2003; accepted after revision 24 July 2003.

* Corresponding author. Tel.: +44-20-8869-2547; fax: +44-20-8869-0075. roxy.senior{at}virgin.net


  Abstract

Objectives: To demonstrate whether the improved imaging quality gained by using tissue harmonic echocardiography in place of fundamental echocardiography results in the improved risk stratification of patients presenting with non-ST-elevation acute chest pain.

Methods and results: Eighty patients with over 30 min of non-ST-elevation chest pain that had lasted less than 6 h were recruited. All patients underwent resting tissue harmonic and fundamental echocardiographic scans. Diagnosis for acute myocardial infarction was made on a 24 h creatine kinase-MB sample. Echocardiographic images were reported by two experienced blinded observers. Patients were followed up at least 4 months after admission. Endpoints included all-cause mortality, non-fatal myocardial infarction and revascularisation procedures. Tissue harmonic echocardiography allowed assessment of all myocardial segments in all patients compared to 43/78 patients (p<0.001) with fundamental echocardiography. A wall thickening abnormality demonstrated on tissue harmonic echocardiography and not fundamental echocardiography was a significant predictor of index myocardial infarction on admission (p<0.007) and for an adverse cardiac event during follow up (p = 0.002).

Conclusions: Tissue harmonic echocardiography is superior to fundamental echocardiography for accurate assessment of systolic wall thickening and hence risk stratification for patients presenting with acute chest pain and non-diagnostic electrocardiogram changes.

Keywords: acute coronary syndrome; risk stratification; tissue harmonic echocardiography


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