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J Am Soc Echocardiogr. 2013 Aug;26(8):875-84. doi: 10.1016/j.echo.2013.05.011. Epub 2013 Jun 19.

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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Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.



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.


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.


MAD and GLS could accurately distinguish patients with NSTEMIs from controls. During 48.6 ± 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).


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


2D; AUC; Area under the curve; Echocardiography; GLS; Global longitudinal strain; LV; LVEF; Left ventricular; Left ventricular ejection fraction; MAD; MRI; Magnetic resonance imaging; Mitral annular displacement; Mortality; Myocardial infarction; NSTE-ACS; NSTEMI; Non–ST-segment elevation acute coronary syndromes; Non–ST-segment elevation myocardial infarction; ROC; Receiver operating characteristic; ST-segment elevation myocardial infarction; STEMI; Two-dimensional; WMSI; Wall motion score index

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