title: Speckle tracking-derived mitral annular velocities predict mortality in patients with acute coronary syndrome.
abstract: BACKGROUND
  Myocardial ischemia can impair myocardial relaxation and result in increased left ventricular (LV) diastolic pressure. Noninvasive measurements of mitral annular velocities have been used to evaluate LV diastolic pressure. We sought to determine whether mitral annular velocities, derived from novel speckle tracking echocardiography (STE), could predict mortality in patients with acute coronary syndrome (ACS).
  
  
  METHODS
  A total of 246 patients with ACS were retrospectively studied. STE was analyzed offline with the sample volume placed on septal, lateral, inferior, and anterior mitral annulus. Peak early (E') and late (A') diastolic velocities of the mitral annulus were measured and averaged from the four regions. Peak early diastolic mitral inflow velocity (E) was obtained using pulsed-wave Doppler.
  
  
  RESULTS
  Lower E' (P = 0.03), lower A' (P = 0.001), higher E'/A' ratio (P = 0.007), and higher E/E' ratio (P = 0.003) were independently associated with increased risk of death with adjustment for clinical and echocardiographic variables over the follow-up period of 21 months. The optimal cutoff value of E/E' ratio derived from the receiver operating characteristic analysis for predicting death was 30 (area under the curve = 0.65). E/E' ratio greater than 30 was predictive of death in univariate (HR, 2.40; CI, 1.42-4.06; P = 0.001) and multivariate (adjusted HR, 1.91; CI, 1.09-3.32; P = 0.02) models.
  
  
  CONCLUSIONS
  The measurements of mitral annular velocities by STE are predictive of mortality in patients with ACS.
authors.affiliation: Division of Cardiology, Howard University Hospital, Washington, District of Columbia 20060, USA. snapan@howard.edu
authors.forename: Sirikarn
authors.initials: S
authors.lastname: Napan
authors.forename: Thaslim A
authors.initials: TA
authors.lastname: Kassim
authors.forename: Shubhada
authors.initials: S
authors.lastname: Kumar
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Curry
authors.forename: Michael D
authors.initials: MD
authors.lastname: Greenberg
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality*; D004219:District of Columbia / Q000453:epidemiology; D004452:Echocardiography / Q000706:statistics & numerical data*; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate