BackgroundLeft ventricular pump function requires a complex interplay involving myocardial fibers orientated in the longitudinal, oblique and circumferential directions. Long axis dysfunction appears to be an early marker for a number of pathological states. We hypothesized that mitral annular plane systolic excursion (MAPSE) measured during cine-cardiovascular magnetic resonance (CMR) reflects changes in long axis function and may be an early marker for adverse cardiovascular outcomes. The aims of this study were therefore: 1) To assess the feasibility and reproducibility of MAPSE measurements during routine cine-CMR; and 2) To assess whether MAPSE, as a surrogate for long axis function, is a predictor of major adverse cardiovascular events (MACE).MethodsFour hundred consecutive patients undergoing CMR were prospectively enrolled. MAPSE was measured in the 4-chamber cine view. Patients were prospectively followed for major adverse cardiac events (MACE) - death, non-fatal myocardial infarction, hospitalization for heart failure or unstable angina, and late revascularization. Cox proportional hazards regression modeling was used to identify factors independently associated with MACE. Net reclassification improvement (NRI) was calculated to assess whether addition of MAPSE resulted in improved risk reclassification of MACE.ResultsSeventy-two MACE occurred during a median follow-up of 14.5 months. By Kaplan-Meier analysis, patients with lateral MAPSE <1.11 cm (median) experienced significantly higher incidence of MACE than patients with a MAPSE ≥1.11 cm (p = 0.027). After adjustment for established clinical risk factors which were univariate predictors (age, diabetes, hypertension, NYHA class, LV mass), lateral MAPSE remained a significant independent predictor of MACE (HR = 4.384 per cm decrease or 1.344 per 2 mm decrease; p = 0.020). Incorporation of lateral MAPSE into this risk model resulted in a net reclassification improvement (NRI) of 0.18 (p = 0.006).ConclusionsReduced long axis function assessed with lateral MAPSE during cine-CMR is an independent predictor of MACE.

In this study ototoxic effect of ionizing radiation was studied in 70 ears with minimum follow up of 6 months post radiotherapy. Patients of nasopharyngeal carcinoma and with conductive deafness pre radiotherapy were excluded from the study to eliminate mechanical obstruction that may play role in Eustachian tube dysfunction. We found that Eustachian tube dysfunction and conductive deafness were reversible where as Sensorineural hearing loss was an irreversible effect of radiotherapy. Dose of radiation was directly proportional to ototoxicity, minimum 60 Gys of total radiation dose was required to produce significant ototoxicity.

The celiac artery is a reliable anatomical marker with TEE and should be routinely used to locate disease in the descending thoracic aorta.

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