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Open Access Research

Peak systolic velocity using color-coded tissue Doppler imaging, a strong and independent predictor of outcome in acute coronary syndrome patients

Carl Westholm12*, Jonas Johnson3, Anders Sahlen12, Reidar Winter123 and Tomas Jernberg12

Author Affiliations

1 Department of Medicine, Section of Cardiology, Karolinska Institutet, Stockholm, Sweden

2 Departement of Cardiology, Karolinska University Hospital, Stockholm, Sweden

3 School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden

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Cardiovascular Ultrasound 2013, 11:9  doi:10.1186/1476-7120-11-9

Published: 1 April 2013

Abstract

Background

Traditional echocardiographic methods like left ventricular ejection fraction(EF) and wall motion scoring (WMS) and new methods like speckle tracking (ST) based 2D strain carry important prognostic information in acute coronary syndrome (ACS) patients. Parameters from tissue Doppler imaging (TDI), with its high time resolution, may further increase the prognostic value. Peak systolic velocity (PSV) of the basal segments of the left ventricle from TDI is a robust and user independent parameter. The aim was to investigate the prognostic value of PSV compared to EF, WMS, 2D strain and E/e'.

Methods

Echocardiographic images were collected and post processed in 227 ACS patients. Additional clinical data was prospectively gathered and patients were followed for 3-5 years regarding the combined endpoint of death or re-admission due to ACS or heart failure.

Results

The combined endpoint occurred in 85 (37%) patients. Those with an event had lower median PSV than those without (4,4 cm/s) vs. (5,3 cm/s), (p<0.001). In a ROC analysis, the AUC was larger for PSV (0.75) than for EF (0.68), WMS (0.63), 2D strain (0.67) and E/e'(0.70). The combined endpoint increased with decreasing PSV. When adjusting for differences in baseline characteristics in a COX-regression model, PSV remained independently associated with outcome where the others did not. PSV was also less sensitive to image quality with fewer values missing or unacceptable for analysis.

Conclusion

Peak systolic velocity (PSV) is a robust measurement that seems to have a strong and independent association with outcome compared to traditional echocardiographic measurements in ACS patients.

Keywords:
Acute coronary syndrome; Prognostic parameters; Tissue Doppler; Peak systolic velocity