Yan Chengxi, Chang Ying, Yang Minglei, Dai Shuangfeng, Zhang Jiannan, Zhang Yuelang
Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China.
Int J Cardiol Heart Vasc. 2024 Nov 30;56:101567. doi: 10.1016/j.ijcha.2024.101567. eCollection 2025 Feb.
To evaluate the prognostic value of lateral mitral annular plane systolic excursion (MAPSE) in the prediction of major adverse cardiology events (MACE) in patients with suspected coronary artery disease (CAD).
233 consecutive patients were enrolled with suspected CAD from October 2012 to September 2013 and performed contrast-enhanced cardiac magnetic resonance (CMR) and two-dimensional echocardiogram studies no later than 72 h after admission. CMR imaging protocol included 4-chamber cine(cine-CMR), cardiovascular magnetic resonance angiography (CMRA) and late gadolinium enhancement (LGE). The primary endpoint is the time of first occurrence of a MACE The independent association between lateral MAPSE and MACE was evaluated by Kaplan-Meier analysis and multivariable Cox regression analysis. C statistic and net reclassification improvement (NRI) were used to evaluate the prognostic value of lateral MAPSE in MACE.
Forty-five MACE occurred during an average follow-up of 9.2 years. Patients with lateral MAPSE＜9.885 mm experienced a significantly higher incidence of MACE than patients with lateral MAPSE ≥ 9.885 mm (＜0.001). After adjustment for established univariate predictors (age, diabetes, hypertension, hypercholesterolemia, transmural myocardial infarction), lateral MAPSE remained a significant independent predictor of MACE (HR = 1.373; = 0.020). The incorporation of lateral MAPSE into the risk model resulted in significant improvement in C statistic (increasing from 0.668 to 0.844; = 0.005). NRI improvement was 0.33 (＜0.001).
lateral MAPSE derived from cine-CMR is an independent predictor of MACE, and improve risk reclassification beyond traditional clinical and CMR risk factors in patients with suspected coronary disease.
评估二尖瓣环平面外侧收缩期位移（MAPSE）对疑似冠心病（CAD）患者主要不良心血管事件（MACE）的预测价值。
连续纳入2012年10月至2013年9月期间233例疑似CAD患者，入院后72小时内进行对比增强心脏磁共振（CMR）和二维超声心动图检查。CMR成像方案包括四腔电影（电影CMR）、心血管磁共振血管造影（CMRA）和延迟钆增强（LGE）。主要终点是首次发生MACE的时间。通过Kaplan-Meier分析和多变量Cox回归分析评估外侧MAPSE与MACE之间的独立关联。C统计量和净重新分类改善（NRI）用于评估外侧MAPSE对MACE的预后价值。
在平均9.2年的随访期间发生了45例MACE。外侧MAPSE＜9.885mm的患者MACE发生率显著高于外侧MAPSE≥9.885mm的患者（＜0.001）。在对已确定的单变量预测因素（年龄、糖尿病、高血压、高胆固醇血症、透壁心肌梗死）进行调整后，外侧MAPSE仍然是MACE的显著独立预测因素（HR = 1.373； = 0.020）。将外侧MAPSE纳入风险模型导致C统计量显著改善（从0.668增加到0.844； = 0.005）。NRI改善为0.33（＜0.001）。
电影CMR得出的外侧MAPSE是MACE的独立预测因素，并且在疑似冠心病患者中，其改善风险重新分类的能力超过传统临床和CMR风险因素。
