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

Eur J Echocardiogr. 2004 Mar;5(2):142-8. doi: 10.1016/S1525-2167(03)00077-5.


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.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Aged
  • Angioplasty, Balloon, Coronary
  • Chest Pain / diagnosis*
  • Chest Pain / epidemiology*
  • Chest Pain / therapy
  • Coronary Artery Bypass
  • Echocardiography*
  • Electrocardiography*
  • Female
  • Follow-Up Studies
  • Heart Conduction System / diagnostic imaging
  • Heart Conduction System / pathology
  • Humans
  • Image Enhancement
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / therapy
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Treatment Outcome
  • United Kingdom