Author + information
- Received August 13, 2018
- Revision received September 17, 2018
- Accepted October 3, 2018
- Published online January 16, 2019.
- Simone Romano, MDa,b,
- Robert M. Judd, PhDc,
- Raymond J. Kim, MDc,
- Han W. Kim, MDc,
- John F. Heitner, MDd,
- Dipan J. Shah, MDe,
- Richard B. Devereux, MDf,
- Pablo Salazar, MDa,
- Michael Trybula, MDa,
- Richard C. Chia, MDa,
- Kaleigh Evans, MDa and
- Afshin Farzaneh-Far, MD, PhDa,∗ ()
- aDepartment of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
- bDepartment of Medicine, University of Verona, Verona, Italy
- cDepartment of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
- dDepartment of Cardiology, New York Methodist Hospital, New York, New York
- eHouston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- fDivision of Cardiology, Weill Cornell Medical College, New York, New York
- ↵∗Address for correspondence:
Dr. Afshin Farzaneh-Far, University of Illinois at Chicago, Section of Cardiology, 840 South Wood Street, M/C 715, Suite 920 S, Chicago, Illinois 60612.
Objectives This study sought to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived mitral annular plane systolic excursion (MAPSE) in a large multicenter population of patients with hypertension.
Background In patients with hypertension, cardiac abnormalities are powerful predictors of adverse outcomes. Long-axis mitral annular movement plays a fundamental role in cardiac mechanics and is an early marker for a number of pathological processes. Given the adverse consequences of cardiac involvement in hypertension, the authors hypothesized that lateral MAPSE may provide incremental prognostic information in these patients.
Methods Consecutive patients with hypertension and a clinical indication for CMR at 4 U.S. medical centers were included in this study (n = 1,735). Lateral MAPSE was measured in the 4-chamber cine view. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models.
Results Over a median follow-up period of 5.1 years, 235 patients died. By Kaplan-Meier analysis, risk of death was significantly higher in patients with a lateral MAPSE < median (10 mm) (log-rank; p < 0.0001). Lateral MAPSE was associated with risk of death after adjustment for clinical and imaging risk factors (hazard ratio [HR]: 1.402-per-millimeter decrease; p < 0.001). Addition of lateral MAPSE in this model resulted in significant improvement in the C-statistic (0.735 to 0.815; p < 0.0001). Continuous net reclassification improvement was 0.739 (95% confidence interval: 0.601 to 0.902). Lateral MAPSE remained significantly associated with death even after adjustment for feature tracking global longitudinal strain (HR: 1.192-per-millimeter decrease; p < 0.001). Lateral MAPSE was independently associated with death among the subgroups of patients with preserved ejection fraction (HR = 1.339; p < 0.001) and in those without history of myocardial infarction (HR: 1.390; p < 0.001).
Conclusions CMR-derived lateral MAPSE is a powerful, independent predictor of mortality in patients with hypertension and a clinical indication for CMR, incremental to common clinical and CMR risk factors. These findings may suggest a role for CMR-derived lateral MAPSE in identifying hypertensive patients at highest risk of death.
- atrioventricular plane displacement
- cardiac magnetic resonance imaging
- global longitudinal strain
- left ventricular function
- mitral annular plane systolic excursion
Dr. Judd holds ownership interest in Heart Imaging Technologies. Dr. Kim is co-founder of HeartIT. All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 13, 2018.
- Revision received September 17, 2018.
- Accepted October 3, 2018.
- 2019 American College of Cardiology Foundation
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