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

Abstract

BackgroundTraditional 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'.MethodsEchocardiographic 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.ResultsThe 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.ConclusionPeak 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.

Testosterone Therapy: An Assessment of the Clinical Consequences of Changes in Hematocrit and Blood Flow Characteristics

“…Changes in macrovascular flow characteristics that may be associated with increased haematocrit are also potentially important. Both end diastolic and peak systolic velocities have been associated with atherogenesis [72][73][74][75][76]. Our research group found that lower peak systolic velocity, based on ultrasound measurements in the carotid artery, was associated with coronary heart disease [72].…”

Effect of High Intensity Interval Training on Cardiac Function in Children with Obesity: A Randomised Controlled Trial

“…Pairwise comparisons for LV S', V max LVOT , and stroke volume index at peak exercise revealed that while there were no differences between HIIT and MICT interventions, the exercise interventions were superior to nutrition advice only for eliciting improvements in these outcomes ( Figure 3 B & D). Importantly, the estimated mean differences between the exercise and nutrition groups for peak exercising LV S' were clinically significant 11 . The exercise interventions increased recovery systolic cardiac function (LV S') compared to the nutrition only intervention while the HIIT group exhibited greater improvements in recovery diastolic cardiac function (LV e') compared to the nutrition only group (Supplemental Table 3).…”

“…For calculation of sample size, the clinically meaningful difference in peak systolic tissue velocity was set to 1cm/s with a standard deviation of 0.9cm/s 11 An intention-to-treat (HIIT=33; MICT=32; nutrition=34) and per protocol analysis (HIIT=17; MICT=24; nutrition=21) was conducted for the LMM. All available data were…”

“…Alterations in cardiac function may be unmasked earlier and be more pronounced during peak exercise 5 which highlights the importance of maximal exercise testing in this population 10 . Prognostically, S' is a strong and independent predictor of event-free survival in adults with acute coronary syndrome, is robust and can be easily obtained during rest and exercise 11 . Subclinical impairments in cardiac function may be accompanied by endothelial dysfunction as assessed by brachial artery flow-mediated dilation [12][13][14] , supporting the notion that children with obesity are at increased risk for development of CV disease (CVD) when compared to children with a healthy weight.…”

“…Importantly, improvements in tissue Doppler velocities bear prognostic significance. Westholm et al (2013) illustrated that a 0.9cm/s reduction in systolic cardiac function (LV S') was associated with all-cause mortality, myocardial infarction or rehospitalisation for heart failure in acute coronary syndrome patients 11 . While this observation may appear irrelevant to children with obesity, this population exhibits markedly diminished cardiac function and significant alterations in cardiac structure, when compared to healthy-weight counterparts.…”