Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Department of Medicine, University of Verona, Verona, Italy.
Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina.
JACC Cardiovasc Imaging. 2019 Sep;12(9):1769-1779. doi: 10.1016/j.jcmg.2018.10.003. Epub 2018 Nov 5.
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.
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.
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.
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).
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.
本研究旨在评估心脏磁共振（CMR）衍生的二尖瓣环平面收缩期位移（MAPSE）在高血压患者这一大规模多中心人群中的预后价值。
在高血压患者中，心脏异常是不良预后的有力预测因素。长轴二尖瓣环运动在心脏力学中起着基本作用，是许多病理过程的早期标志物。鉴于高血压中心脏受累的不良后果，作者假设外侧 MAPSE 可能为这些患者提供额外的预后信息。
连续纳入 4 家美国医疗中心因临床指征行 CMR 的高血压患者（n=1735）。在 4 腔心电影视图中测量外侧 MAPSE。主要终点是全因死亡。Cox 比例风险回归模型用于检验外侧 MAPSE 与死亡之间的关联。嵌套模型评估了外侧 MAPSE 的增量预后价值。
中位随访 5.1 年后，有 235 名患者死亡。通过 Kaplan-Meier 分析，MAPSE ＜ 中位数（10mm）患者的死亡风险显著更高（对数秩检验；p＜0.0001）。外侧 MAPSE 与调整后的临床和影像学危险因素后死亡风险相关（风险比[HR]：每毫米减少 1.402；p＜0.001）。在该模型中加入外侧 MAPSE 可显著提高 C 统计量（从 0.735 提高至 0.815；p＜0.0001）。连续净重新分类改善为 0.739（95%置信区间：0.601 至 0.902）。即使调整特征跟踪整体纵向应变后，外侧 MAPSE 仍与死亡显著相关（HR：每毫米减少 1.192；p＜0.001）。外侧 MAPSE 在射血分数保留的患者亚组（HR=1.339；p＜0.001）和无心肌梗死病史的患者亚组（HR：1.390；p＜0.001）中与死亡独立相关。
CMR 衍生的外侧 MAPSE 是高血压患者行 CMR 临床指征患者死亡率的有力、独立预测因素，比常见的临床和 CMR 危险因素更具增量价值。这些发现可能提示 CMR 衍生的外侧 MAPSE 可用于识别死亡风险最高的高血压患者。
