Abstract 15856: Left Ventricular Longitudinal Contractility Measured During Routine Cine-cardiac Magnetic Resonance Imaging is an Independent Predictor of Adverse Cardiac Events

Abstract

Background: Left ventricular systole involves coordinated contraction of longitudinal, circumferential, and radial myocardial fibers. Longitudinal fiber dysfunction appears to be an early marker for a number of pathological states. We hypothesized that reduced mitral annular plane systolic excursion (MAPSE) measured during cine-Cardiac Magnetic Resonance (CMR) imaging reflects changes in longitudinal fiber function and may be an early marker for adverse cardiovascular outcomes. Methods: 400 consecutive patients with known or suspected coronary artery disease undergoing CMR were prospectively enrolled. Lateral MAPSE was measured in the 4-chamber cine view by two independent observers. Patients were prospectively followed for major adverse cardiac events (MACE) - death, non-fatal myocardial infarction, hospitalization for heart failure or chest pain, and late revascularization. Cox proportional hazards regression modeling was used to identify factors independently associated with MACE. Results: The mean age of the study population was 58(±15) years, with a mean ejection fraction of 59(±14%). 31% of the individuals had known coronary artery disease and 33% were diabetic. 72 MACE occurred during a median follow-up of 14.5 months. By Kaplan-Meier analysis, patients with lateral MAPSE ≤1.11cm (median) experienced significantly higher incidence of MACE than patients with a MAPSE >1.11cm (p = 0.0270) (Figure). After adjustment for established predictors (ejection fraction, age, sex, diabetes, hyperlipidemia, smoking, hypertension, late gadolinium enhancement) lateral MAPSE remained a significant independent predictor of MACE (HR=2.43 per cm decrease; p=0.037). Conclusions: Reduced longitudinal fiber function assessed with lateral MAPSE during cine-CMR is an independent predictor of MACE in patients with known or suspected coronary artery disease. Figure: Kaplan-Meier curves for MACE in patients with MAPSE above and below the median.