Cardiac magnetic resonance (CMR) derived mitral annular plane systolic excursion (MAPSE) is a significant independent predictor of mortality in patients with hypertension and a clinical indication for CMR, according to research published Nov. 5 in JACC: Cardiovascular Imaging, which will be presented at AHA 2018 in Chicago, IL.

Simone Romano, MD, et al., examined 1,735 patients with hypertension and a clinical indication for CMR. Lateral-MAPSE was measured in the four-chamber cine-view. Cox proportional hazards regression modeling was used to examine the association between lateral-MAPSE and the primary endpoint of all-cause death.

Results showed that a total of 235 patients died during a median follow-up period of 5.1 years. There was a significantly increased risk of death in those with lateral MAPSE less than the median of 10mm (log-rank p<0.0001). After multivariate adjustment for clinical and imaging risk factors, each 1mm worsening in lateral MAPSE was associated with a 40.2 percent increase risk of death. The addition of lateral MAPSE into the model with clinical and imaging predictors resulted in significant increase in the C-statistic (from 0.735 to 0.815 p<0.0001) and a significant increase in model Chi square value (from 143.0 to 293.6; p<0.001). This was associated with significant integrated discrimination improvement of 0.114 (95 percent CI, 0.079-0.156), and a continuous net reclassification improvement of 0.739 (95 percent CI, 0.601-0.902). Global longitudinal strain remained a significant predictor of events in the final multivariable model (HR=1.180; p<0.001). Lateral-MAPSE was independently associated with death amongst the subgroup of patients with preserved ejection fraction and in those without history of myocardial infarction.

"These findings highlight the importance of long-axis function in individuals with hypertension and suggest a role for CMR derived lateral MAPSE in identifying hypertensive patients at highest risk of death," the authors write. However, they caution that, "How this information will affect clinical care requires further investigation and future studies are warranted to explore the role of CMR derived lateral MAPSE in clinical decision-making. These studies will need to demonstrate that imaging driven patient management improves specific outcomes before such an approach could be advocated."

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Hypertension

Keywords: AHA18, AHA Annual Scientific Sessions, Stroke Volume, Systole, Proportional Hazards Models, Myocardial Infarction, Hypertension, Magnetic Resonance Spectroscopy

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