Key result
Decreased mitral annular plane systolic excursion (< 9 mm) assessed by cardiac MRI independently predicted major adverse cardiovascular events following STEMI with a hazard ratio of 6.02.
Why the study?
The comparative prognostic value of MAPSE versus LVEF measured by CMR in STEMI patients treated with pPCI was unknown.
Does MAPSE measured by CMR improve prognostic assessment compared to LVEF in patients with STEMI treated with pPCI?
Observational (n=255)
No
Does MAPSE measured by CMR improve prognostic assessment compared to LVEF in patients with STEMI treated with pPCI?
Effect estimate: HR 6.02 (95% CI 2.47-14.68)
p-value: p=<0.001
Septal MAPSE measured by CMR is a simple and independent predictor of long-term MACE after STEMI, offering superior prognostic value compared to conventional LVEF.
OBJECTIVES: The purpose of this study was to assess the comparative prognostic value of mitral annular plane systolic excursion (MAPSE) versus left ventricular ejection fraction (LVEF), measured by cardiac magnetic resonance (CMR) imaging in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). METHODS: CMR was performed in 255 STEMI patients within 2 days (interquartile range (IQR) 2-4 days) after infarction. CMR included MAPSE measurement on CINE 4-chamber view. Patients were followed for major adverse cardiovascular events (MACE)-death, non-fatal myocardial re-infarction, stroke, and new congestive heart failure. RESULTS: Patients with MACE (n = 35, 14%, median follow-up 3 years [IQR 1-4 years]) showed significantly lower MAPSE (8 mm [7-8.8] vs. 9.6 mm [8.1-11.5], p < 0.001). The association between decreased MAPSE (< 9 mm, optimal cut-off value by c-statistics) remained significant after adjustment for independent clinical and CMR predictors of MACE. The AUC of MAPSE for the prediction of MACE was 0.74 (CI 95% 0.65-0.82), significantly higher than that of LVEF (0.61 [CI 95% 0.50-0.71]; p < 0.001). CONCLUSIONS: Reduced long-axis function assessed with MAPSE measurement using CINE CMR independently predicts long-term prognosis following STEMI. Moreover, MAPSE provided significantly higher prognostic implication in comparison with conventional LVEF measurement. KEY POINTS: • MAPSE determined by CMR independently predicts long-term prognosis following STEMI. • MACE-free survival is significantly higher in patients with MAPSE ≥ 9 mm than < 9 mm. • MAPSE provides significantly higher prognostic implication than conventional LVEF.
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Mayr et al. (2019) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=255). Mitral annular plane systolic excursion (MAPSE) < 9 mm vs. MAPSE ≥ 9 mm was evaluated on Major adverse cardiovascular events (MACE) (HR 6.02, 95% CI 2.47-14.68, p=<0.001). Decreased mitral annular plane systolic excursion (< 9 mm) assessed by cardiac MRI independently predicted major adverse cardiovascular events following STEMI with a hazard ratio of 6.02.
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