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The following is a summary of “Tissue-tracking mitral annular displacement predicts impaired left ventricular mechanics and adverse outcomes in aortic stenosis with preserved left ventricular ejection fraction,” published in the March 2025 issue of the Journal of the International Journal of Cardiology by Takahari et al.

Tissue-tracking mitral annular displacement (TMAD) is an emerging, simplified echocardiographic marker of left ventricular (LV) longitudinal systolic function. While TMAD has demonstrated potential as a surrogate for LV contractility, its prognostic significance in patients with aortic stenosis (AS) remains uncertain. This study aimed to assess the clinical relevance of TMAD in AS by evaluating its correlation with global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF), as well as its predictive value for adverse cardiovascular outcomes. Researchers conducted a retrospective analysis of 91 patients with moderate or severe AS and preserved LVEF (≥50%). TMAD was measured using an apical four-chamber view and indexed to LV long-axis length (%TMAD). 

Correlations between %TMAD, LVEF, GLS, and regional longitudinal strain (LS) at the apical, mid, and basal LV segments were analyzed. Furthermore, the study group examined the association between %TMAD and clinical outcomes, including cardiovascular mortality, heart failure hospitalization, and unplanned aortic valve replacement. Their findings revealed that %TMAD exhibited a moderate correlation with LVEF (r = 0.45, P < 0.001) and a strong correlation with GLS (r = 0.81, P < 0.001). In the regional LS assessment, %TMAD showed a stronger correlation with mid and basal LS than with apical LS, suggesting its primary role in reflecting mid-basal LV systolic function. A %TMAD threshold of 9.8% was identified as predictive of impaired GLS (|GLS| < 14.7%), a previously established marker of subclinical LV dysfunction. Moreover, a %TMAD below this cutoff was significantly associated with worse event-free survival (log-rank P = 0.001). 

In a multivariable Cox proportional hazards model, lower %TMAD independently predicted adverse cardiovascular outcomes, irrespective of AS severity and LVEF. These findings underscore %TMAD as a valuable echocardiographic parameter for assessing LV systolic function in AS, particularly in the mid-basal segments, where early myocardial dysfunction may develop. Furthermore, its strong prognostic implications highlight its potential role in risk stratification and clinical decision-making for patients with AS with preserved ejection fraction. Future studies are warranted to validate these results in larger cohorts and to explore whether %TMAD-guided assessment can refine timing for aortic valve intervention.

Source: internationaljournalofcardiology.com/article/S0167-5273(25)00149-4/abstract