title: Ventricular longitudinal function is associated with microvascular obstruction and intramyocardial haemorrhage.
abstract: Microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) are associated with adverse prognosis, independently of infarct size after reperfused ST-elevation myocardial infarction (STEMI). Mitral annular plane systolic excursion (MAPSE) is a well-established parameter of longitudinal function on echocardiography.
  
  
  
  We aimed to investigate how acute MAPSE, assessed by a four-chamber cine-cardiovascular MR (CMR), is associated with MVO, IMH and convalescent left ventricular (LV) remodelling.
  
  
  
  54 consecutive patients underwent CMR at 3T (Intera CV, Philips Healthcare, Best, The Netherlands) within 3 days of reperfused STEMI. Cine, T2-weighted, T2* and late gadolinium enhancement (LGE) imaging were performed. Infarct and MVO extent were measured from LGE images. The presence of IMH was investigated by combined analysis of T2w and T2* images. Averaged-MAPSE (medial-MAPSE+lateral-MAPSE/2) was calculated from 4-chamber cine imaging.
  
  
  
  44 patients completed the baseline scan and 38 patients completed 3-month scans. 26 (59%) patients had MVO and 25 (57%) patients had IMH. Presence of MVO and IMH were associated with lower averaged-MAPSE (11.7±0.4 mm vs 9.3±0.3 mm; p<0.001 and 11.8±0.4 mm vs 9.2±0.3 mm; p<0.001, respectively). IMH (β=-0.655, p<0.001) and MVO (β=-0.567, p<0.001) demonstrated a stronger correlation to MAPSE than other demographic and infarct characteristics. MAPSE ≤10.6 mm demonstrated 89% sensitivity and 72% specificity for the detection of MVO and 92% sensitivity and 74% specificity for IMH. LV remodelling in convalescence was not associated with MAPSE (AUC 0.62, 95% CI 0.44 to 0.77, p=0.22).
  
  
  
  Postreperfused STEMI, LV longitudinal function assessed by MAPSE can independently predict the presence of MVO and IMH.
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: Pankaj
authors.identifier: 0000-0002-5483-169X
authors.initials: P
authors.lastname: Garg
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: Ananth
authors.identifier: 0000-0002-0939-7900
authors.initials: A
authors.lastname: Kidambi
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: James R J
authors.initials: JR
authors.lastname: Foley
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: Tarique Al
authors.initials: TA
authors.lastname: Musa
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: David P
authors.initials: DP
authors.lastname: Ripley
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Swoboda
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: Bara
authors.initials: B
authors.lastname: Erhayiem
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dobson
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: Adam K
authors.initials: AK
authors.lastname: McDiarmid
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
authors.affiliation: Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK.
authors.forename: Sven
authors.initials: S
authors.lastname: Plein