title: Mitral annular displacement by Doppler tissue imaging may identify coronary occlusion and predict mortality in patients with non-ST-elevation myocardial infarction.
abstract: BACKGROUND
  Mitral annular displacement (MAD) is a simple marker of left ventricular (LV) systolic function. The aim of this study was to test the hypothesis that MAD can distinguish patients with non-ST-segment elevation myocardial infarctions (NSTEMIs) from those with significant coronary artery disease without infarctions, identify coronary occlusion, and predict mortality in patients with NSTEMIs. MAD was compared with established indices of LV function.
  
  
  METHODS
  In this retrospective study, 167 patients with confirmed NSTEMIs were included at two Scandinavian centers. Forty patients with significant coronary artery disease but without myocardial infarctions were included as controls. Doppler tissue imaging was performed at the mitral level of the left ventricle in the three apical planes, and velocities were integrated over time to acquire MAD. LV ejection fraction, global longitudinal strain (GLS), and wall motion score index were assessed according to guidelines.
  
  
  RESULTS
  MAD and GLS could accurately distinguish patients with NSTEMIs from controls. During 48.6 ± 12.1 months of follow-up, 22 of 167 died (13%). MAD, LV ejection fraction, and GLS were reduced and wall motion score index was increased among those who died compared with those who survived (P < .001, P < .001, P < .001, and P = .02, respectively). Multivariate Cox proportional-hazards analyses revealed that MAD was an independent predictor of death (hazard ratio, 1.36; 95% confidence interval, 1.07-1.73; P = .01). MAD and GLS were reduced and wall motion score index was increased in patients with coronary artery occlusion compared with those without occlusion (P = .006, P = .001, and P = .02), while LV ejection fraction did not differ (P = .20).
  
  
  CONCLUSIONS
  MAD accurately identified patients with NSTEMIs, predicted mortality, and identified coronary occlusion in patients with NSTEMIs.
authors.affiliation: Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.
authors.forename: Wasim
authors.initials: W
authors.lastname: Zahid
authors.forename: Jonas
authors.initials: J
authors.lastname: Johnson
authors.forename: Carl
authors.initials: C
authors.lastname: Westholm
authors.forename: Christian H
authors.initials: CH
authors.lastname: Eek
authors.forename: Kristina H
authors.initials: KH
authors.lastname: Haugaa
authors.forename: Marit Kristine
authors.initials: MK
authors.lastname: Smedsrud
authors.forename: Helge
authors.initials: H
authors.lastname: Skulstad
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
authors.forename: Reidar
authors.initials: R
authors.lastname: Winter
authors.forename: Thor
authors.initials: T
authors.lastname: Edvardsen
mesh_terms: D015897:Comorbidity; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality*; D009664:Norway / Q000453:epidemiology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology
keywords: 2D; AUC; Area under the curve; Echocardiography; GLS; Global longitudinal strain; LV; LVEF; Left ventricular; Left ventricular ejection fraction; MAD; MRI; Magnetic resonance imaging; Mitral annular displacement; Mortality; Myocardial infarction; NSTE-ACS; NSTEMI; Non–ST-segment elevation acute coronary syndromes; Non–ST-segment elevation myocardial infarction; ROC; Receiver operating characteristic; ST-segment elevation myocardial infarction; STEMI; Two-dimensional; WMSI; Wall motion score index