title: Independent value of tissue harmonic echocardiography for risk stratification in patients with non-ST-segment elevation acute chest pain.
abstract: BACKGROUND
  Clinical factors, electrocardiography, and cardiac troponins provide a satisfactory, although not ideal, means for risk-stratifying patients with non-ST-segment elevation acute chest pain. Tissue harmonic echocardiography enables improved assessment of wall motion abnormalities compared with fundamental echocardiography and may be a useful adjunct for the detection of myocardial ischemia and infarction. We aimed to determine the value of tissue harmonic echocardiography in relation to electrocardiographic and biochemical factors for risk stratification of these patients.
  
  
  RESULTS
  Eighty patients with non-ST-segment elevation chest pain were studied using tissue harmonic echocardiography and troponin-T and -I. Fifty-five (69%) patients had abnormal electrocardiograms and 47 (59%) patients had abnormal echocardiograms. Thirteen patients (17%) had elevated troponin-T levels and 17 (21%) had elevated levels of troponin-I. Twelve patients (15%) had a myocardial infarction as the presenting event and, of the remaining 68 patients, 24 sustained an adverse cardiac event during the follow-up period (3 cardiac deaths, 4 nonfatal myocardial infarctions, 17 revascularization procedures). Troponin-T (98%), troponin-I (97%), and echocardiography (97%) all had similar negative predictive values for myocardial infarction as the presenting event, but troponin-T was the only independent predictor of this endpoint (relative risk 230, 95% CI 22-2427). An abnormal echocardiogram was the only independent predictor of subsequent events. The independent predictors of all events were age, troponin-T, and echocardiography.
  
  
  CONCLUSIONS
  Tissue harmonic echocardiography provides independent information for risk stratification of patients with non-ST-segment elevation acute chest pain.
authors.affiliation: Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, UK.
authors.forename: Johnathan M A
authors.initials: JM
authors.lastname: Swinburn
authors.forename: Peter
authors.initials: P
authors.lastname: Stubbs
authors.forename: Prem
authors.initials: P
authors.lastname: Soman
authors.forename: Paul
authors.initials: P
authors.lastname: Collinson
authors.forename: Avijit
authors.initials: A
authors.lastname: Lahiri
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000097:blood* / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
chemical_list: D019210:Troponin I; D020107:Troponin T