Tissue Mitral Annular Displacement in Patients With Myocardial Infarction　― Comparison With Global Longitudinal Strain ―

Figures

• 

  Figure 1.. Representative images in patients with inferior myocardial infarction (MI). Longitudinal strain and tissue mitral annular displacement measured from apical 4-chamber views (TMAD4ch) from 2 patients with inferior MI. (Left) Segmental peak longitudinal strain values are shown on a bull’s eye plot. (Right) The movement of regions of interest (ROIs) on both sides of the mitral annulus towards the apex during systole was traced, and the movement of the midpoint of annular ROIs was indexed by left ventricle (LV) length to calculate TMAD. In Case A, global longitudinal strain (GLS) was 19.5% and TMAD4ch was 12.2%; in Case B, reductions were seen in both GLS (12.2%) and TMAD4ch (9.6%). ANT, anterior; INF, inferior; LAT, lateral; SEPT, septum.

• 

  Figure 2.. Correlations among tissue mitral annular displacement (TMAD) and other echocardiographic parameters. (Upper) There were good correlations among TMAD parameters (TMAD measured apical 4- and 2-chamber views [TMAD4ch and TMAD2ch, respectively], mean TMAD [TMADav]). All TMAD parameters showed good correlations with global longitudinal strain (GLS; Middle) and moderate correlations with left ventricular ejection fraction (LVEF; Lower). R values are given on each plot, with 95% confidence intervals in parentheses.

• 

  Figure 3.. Correlations among echocardiographic parameters and left ventricular ejection fraction (LVEF) at 6 months after myocardial infarction. (Upper) There were significant correlations between LVEF at 6 months and all tissue mitral annular displacement (TMAD) parameters. There were also significant correlations between LVEF at 6 months and global longitudinal strain (GLS; Lower left) and LVEF at 2 weeks (Lower right). R values are given on each plot, with 95% confidence intervals in parentheses.

• 

  Figure 4.. Kaplan-Meier curves for all-cause death in patients with myocardial infarction. All-cause mortality during the follow-up period (median 735 days) was analyzed among 204 patients in whom global longitudinal strain (GLS) and tissue mitral annular displacement from apical 4- and 2-chamber views (TMAD4ch and TMAD2ch, respectively) were all measured. (A) Kaplan-Meier curves among patients divided according to quartiles of mean TMAD (TMADav): upper 25% (Q1; >14.7%), middle range (Q2–3; 10.7–14.7%), and lower 25% (Q4; <10.7%). Patients in Q1 had higher mortality than those in the other groups (P=0.041, log-rank test). (B) Kaplan-Meier curves among patients divided into 2 groups based on TMADav. Mortality was higher for patients with TMADav ≤8.0% than >8.0% (P=0.023). (C) Dividing patients into groups based on the interquartile range of GLS (Q1 [>19.2%], Q2–3 [14.5 to 19.2%], and Q4 [<14.5%]) revealed no significantly associations with mortality (P=0.058). (D) GLS was associated with all-cause mortality when patients were divided into 2 groups using 15.0% as a cut-off value.