Mitral Annular Displacement by Doppler Tissue Imaging May Identify Coronary Occlusion and Predict Mortality in Patients with Non-ST-Elevation Myocardial Infarction

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• 作者：Wasim Zahid ; Jonas Johnson ; Carl Westholm ; Christian H. Eek ; Kristina H. Haugaa ; Marit Kristine Smedsrud ; Helge Skulstad ; Erik Fosse ; Reidar Winter ; Thor Edvardsen
• 关键词：Myocardial infarction ; Mortality ; Echocardiography
• 刊名：Journal of the American Society of Echocardiography
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：26
• 期：8
• 页码：875-884
• 全文大小：1513 K

文摘

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Background

Mitral annular displacement (MAD) is a simple marker of left ventricular (LV) systolic function. The aim of this study was to test the hypothesis that MAD can distinguish patients with non-ST-segment elevation myocardial infarctions (NSTEMIs) from those with significant coronary artery disease without infarctions, identify coronary occlusion, and predict mortality in patients with NSTEMIs. MAD was compared with established indices of LV function.

Methods

In this retrospective study, 167 patients with confirmed NSTEMIs were included at two Scandinavian centers. Forty patients with significant coronary artery disease but without myocardial infarctions were included as controls. Doppler tissue imaging was performed at the mitral level of the left ventricle in the three apical planes, and velocities were integrated over time to acquire MAD. LV ejection fraction, global longitudinal strain (GLS), and wall motion score index were assessed according to guidelines.

Results

MAD and GLS could accurately distinguish patients with NSTEMIs from controls. During 48.6 ¡À 12.1?months of follow-up, 22 of 167 died (13 % ). MAD, LV ejection fraction, and GLS were reduced and wall motion score index was increased among those who died compared with those who survived (P < .001, P?< .001, P < .001, and P?= .02, respectively). Multivariate Cox proportional-hazards analyses revealed that?MAD was an independent predictor of death (hazard ratio, 1.36; 95 % confidence interval, 1.07-1.73; P?= .01). MAD and GLS were reduced and wall motion score index was increased in patients with coronary artery occlusion compared with those without occlusion (P?= .006, P?= .001, and P?= .02), while LV ejection fraction did not differ (P?= .20).

Conclusions

MAD accurately identified patients with NSTEMIs, predicted mortality, and identified coronary occlusion in patients with NSTEMIs.