Mitral Annular Plane Systolic Excursion (MAPSE) as a Simple Index for Assessing Left Ventricular Function: An Observational Study

Ashutosh Prasad Tripathi,J S Satyanarayana Murthy,Jayanti Venkata Balasubramaniyan

doi:10.9734/jpri/2021/v33i59b34366

Abstract

Background: Mitral annular plane systolic excursion (MAPSE) has been proposed as a parameter for assessing left ventricular function. The assessment of LVF has major diagnostic and prognostic implications in patients with cardiovascular diseases. LVF is measured by Left Ventricular Ejection Fraction, however the accuracy of LVEF estimation by two dimensional echocardiography is limited especially in patients with poor image quality. Mitral annular plane systolic excursion (MAPSE) measurement predicts left ventricular function even in conditions with suboptimal echo window. Objective: To assess the correlation of MAPSE derived LVEF with LVEF measured by Modified Simpson’s method. Methods: This is a cross sectional study which included 279 patients admitted at our tertiary care hospital from December 2019 to March 2020 and the patients were divided in two groups. Group A – Patients with LVEF>= 50% and Group B – Patients with LVEF<50%. All patients underwent 2D echocardiographic examination using Modified Simpsons’ method and MAPSE measurement. The VIVID E9, VIVID T8, VIVID E95 and PHILIPS echocardiography machine was used for the non-invasive measurements. MAPSE was recorded at medial and lateral mitral annuli in the apical four-chamber approach. Results: On analysis, a cut off value for average MAPSE-S (medial mitral annuli) was 8.5 was obtained, denoting preserved LV function with sensitivity of 81.7%, specificity of 84.9%, positive predictive value of 91.6% and negative predictive value of 84.9%. The AUC for MAPSE-S was 0.822. Similarly, the cut off value of average MAPSE-L (lateral mitral annuli) was 7.5 denoting impaired LV functions with an AUC of 0.826, sensitivity of 82.8%, specificity of 72.0%, positive predictive value of 85.6% and negative predictive value of 72.0%. The AUC of 82.6% was observed for MAPSE-L. Conclusion: MAPSE reflects longitudinal myocardial shortening. MAPSE is a rapid and sensitive echocardiographic parameter for assessing normal LV function and global LV systolic dysfunction.

Highlights

Left Ventricular Ejection Fraction (LVEF) is a robust and most reliable criterion for assessing Left Ventricular Systolic Function [1-2]
Our study showed a positive correlation between Mitral annular plane systolic excursion (MAPSE) and EF derived from Modified Simpsons’ method
The results of our study revealed the cut of value of MAPSE-S was 8.5, the area under the curve (AUC) was 0.822, sensitivity of 81.7%, specificity of 84.9%, positive predictive value of 91.6% and negative predictive value of 84.9%

Summary

Introduction

Left Ventricular Ejection Fraction (LVEF) is a robust and most reliable criterion for assessing Left Ventricular Systolic Function [1-2]. The most common method widely used for assessing left ventricular systolic function is Two Dimensional Echocardiography. Mitral annular plane systolic excursion (MAPSE) has been proposed as a parameter for assessing left ventricular function. LVF is measured by Left Ventricular Ejection Fraction, the accuracy of LVEF estimation by two dimensional echocardiography is limited especially in patients with poor image quality. Mitral annular plane systolic excursion (MAPSE) measurement predicts left ventricular function even in conditions with suboptimal echo window. The cut off value of average MAPSE-L (lateral mitral annuli) was 7.5 denoting impaired LV functions with an AUC of 0.826, sensitivity of 82.8%, specificity of 72.0%, positive predictive value of 85.6% and negative predictive value of 72.0%. MAPSE is a rapid and sensitive echocardiographic parameter for assessing normal LV function and global LV systolic dysfunction

Objectives

Methods

Results

Conclusion