Prognostic value of mitral annular plane systolic excursion for adverse cardiovascular events in patients with acute myocarditis

Figures

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  Figure 1. Flow chart of the study population.

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  Figure 2. Schematic of left atrial and left ventricular strain and volume analysis. (A,B) Left atrial (LA) volume and strain were assessed based on two-chamber (A) and four-chamber (B) cine images using the biplane equation. (C) Representative LA longitudinal strain curve illustrating reservoir strain (εs), conduit strain (εe), and booster strain (εa).(D) Left ventricular (LV) volume and strain parameters were derived from short-axis and long-axis cine images.

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  Figure 3. Measurement of mitral annular plane systolic excursion (MAPSE) and papillary muscle signal intensity. (A) Illustration of MAPSE measurement on a four-chamber cine image. The mitral annular plane was tracked to measure the displacement of the lateral (Lateral MAPSE) and septal (Septal MAPSE) mitral annulus from end-diastole to end-systole. (B) Analysis of papillary muscle signal intensity on a short-axis cine image. Regions of interest were drawn on the anterior and posterior papillary muscles and the interventricular septum to calculate the anterior papillary signal ratio (APS) and posterior papillary signal ratio (PPS).

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  Figure 4. Diagnostic performance of MAPSE (A), left ventricular strain (B), and left atrial strain (C) for adverse cardiovascular events in patients with myocarditis.

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  Figure 5. Prognostic value of MAPSE. Optimal lateral MAPSE (A) and optimal septal MAPSE (B) cutoffs of 11.96 mm and 8.85 mm (log-rank test P = 0.0025, P = 0.0065).

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  Figure 6. Predictive value of different Cox regression models for adverse cardiovascular events in patients with myocarditis. (A) Receiver operating characteristic (ROC) curves comparing the diagnostic performance of Septal MAPSE, Lateral MAPSE, and the combination of both. Lateral MAPSE alone yielded the highest Area Under the Curve (AUC = 0.9065) compared to Septal MAPSE (AUC = 0.8468) and the combined model (AUC = 0.8831). (B) ROC curves comparing multivariate models incorporating Age. The model combining Age and Lateral MAPSE demonstrated the highest predictive value (AUC = 0.9221), which was superior to Age + Septal MAPSE (AUC = 0.8701) and slightly higher than the model combining Age + Lateral MAPSE + Septal MAPSE (AUC = 0.9091).