Left ventricular long axis function assessed during cine-cardiovascular magnetic resonance is an independent predictor of adverse cardiac events.
Left ventricular pump function requires a complex interplay involving myocardial fibers orientated in the longitudinal, oblique and circumferential directions. Long axis dysfunction appears to be an early marker for a number of pathological states. We hypothesized that mitral annular plane systolic excursion (MAPSE) measured during cine-cardiovascular magnetic resonance (CMR) reflects changes in long axis function and may be an early marker for adverse cardiovascular outcomes. The aims of this study were therefore: 1) To assess the feasibility and reproducibility of MAPSE measurements during routine cine-CMR; and 2) To assess whether MAPSE, as a surrogate for long axis function, is a predictor of major adverse cardiovascular events (MACE).



Four hundred consecutive patients undergoing CMR were prospectively enrolled. MAPSE was measured in the 4-chamber cine view. Patients were prospectively followed for major adverse cardiac events (MACE) - death, non-fatal myocardial infarction, hospitalization for heart failure or unstable angina, and late revascularization. Cox proportional hazards regression modeling was used to identify factors independently associated with MACE. Net reclassification improvement (NRI) was calculated to assess whether addition of MAPSE resulted in improved risk reclassification of MACE.



Seventy-two MACE occurred during a median follow-up of 14.5 months. By Kaplan-Meier analysis, patients with lateral MAPSE <1.11 cm (median) experienced significantly higher incidence of MACE than patients with a MAPSE ≥1.11 cm (p = 0.027). After adjustment for established clinical risk factors which were univariate predictors (age, diabetes, hypertension, NYHA class, LV mass), lateral MAPSE remained a significant independent predictor of MACE (HR = 4.384 per cm decrease or 1.344 per 2 mm decrease; p = 0.020). Incorporation of lateral MAPSE into this risk model resulted in a net reclassification improvement (NRI) of 0.18 (p = 0.006).



Reduced long axis function assessed with lateral MAPSE during cine-CMR is an independent predictor of MACE.
Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA.
Vibhav
V
Rangarajan
Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA.
Satish Jacob
SJ
Chacko
Department of Medicine, University of Verona, Verona, Italy.
Simone
S
Romano
Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA.
Jennifer
J
Jue
Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA.
Nikhil
N
Jariwala
Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA.
Jaehoon
J
Chung
Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA. afshin@uic.edu.|Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA. afshin@uic.edu.
Afshin
A
Farzaneh-Far
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D016009:Chi-Square Distribution; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
Atrioventricular plane displacement (AVPD); Cardiovascular magnetic resonance; Left ventricular function; Longitudinal strain; Mitral annular plane systolic excursion; Prognosis