Mitral annular plane systolic excursion on exercise: a simple diagnostic tool for heart failure with preserved ejection fraction

Abstract

AimsCurrent guidelines for the diagnosis of heart failure with normal or preserved ejection fraction (HFpEF) are based on measurements at rest. However, in HFpEF ventricular dysfunction is more apparent on exercise. We hypothesized that Mitral annular plane systolic excursion (MAPSE) which is easy to acquire on exercise could be used to detect occult left ventricular (LV) impairment. Methods and resultsCardiopulmonary exercise testing and 2D-Doppler echocardiography were performed at rest and on exercise. MAPSE was assessed by using M-mode (apical four-chamber view). Sixty-two patients with HFpEF [LV ejection fraction (LVEF)¼60 + 7%] with reduced VO 2 max (18.6 + 5.2 mL/min/kg) and 36 control subjects (LVEF¼62 + 7%, VO 2 max 29.4 + 4.8 mL/min/kg) were studied. MAPSE at rest was significantly lower in patients (10.9 + 2.1 vs. 12.1 + 2.2 mm in controls, P ¼ 0.008) which was even more pronounced on exercise (12.0 + 2.2 mm and 16.2 + 2.7 mm, respectively, P , 0.001). At rest MAPSE correlated with longitudinal strain (r ¼ 0.432, P ¼ 0.001), peak systolic myocardial velocity (r ¼ 0.545, P , 0.001), and early diastolic myocardial velocity (r ¼ 0.322, P ¼ 0.02) and on exercise with LV apical rotation (r ¼ 0.582, P , 0.001), longitudinal strain (r ¼ 0.589, P , 0.001), and myocardial tissue velocities (P , 0.001). The area under the receiver operating characteristic curve for MAPSE was 0.655 (confidence interval 0.540 -0.770) at rest and 0.901 (confidence interval 0.835-0.967) on exercise, to differentiate between patients and controls. ConclusionMitral annular plane systolic excursion at rest and on exercise correlates well with more sophisticated measurements of ventricular function in HFpEF patients. It is potentially a useful and easily acquired measurement, especially on exercise, for the diagnosis of HFpEF.--

Z-Score Reference Ranges for Angular M-Mode Displacement at 22-40 Weeks' Gestation

“…However, longitudinal myocardial motion, as determined by tricuspid and mitral annular plane systolic excursions (TAPSE and MAPSE, respectively), adds significant information to ejection fraction. TAPSE and MAPSE have demonstrated their utility as potentially useful markers of ventricular systolic dysfunction in adult patients with heart failure or valvular disease [2,3] and in children with intrauterine growth restriction (IUGR) [4,5] . It has also been shown to be feasible and reproducible in fetuses [1,[6][7][8] .…”

Echocardiographic Changes in Patients with Stage 3-5 Chronic Kidney Disease and Left Ventricular Diastolic Dysfunction

“…The systolic diameter reduction in the LV short axis is considered to be caused by the contraction of circumferentially oriented fibers, whereas MAPSE has been shown to be the result of the contraction of longitudinally oriented fibers. This is observed in patients with diastolic dysfunction in whom the long-axis function of the left ventricle measured by MAPSE or SmLV is already impaired while the radial function assessed by LVEF can be still preserved [22,23]. In our study, MAPSE was more useful than SmLV to detect LV diastolic and systolic dysfunction in patients with CKD.…”

“…In another study, TDI indices of both LV diastolic and systolic functions correlated significantly with MAPSE in patients with diastolic heart failure, illustrating a close relationship between systolic and diastolic LV functions [23]. Additionally, MAPSE obtained better interobserver reproducibility than other traditional and newer measurements of LV systolic function [25].…”

“…Additionally, the contraction of longitudinally oriented fibers affects the motion of fibrous annuli, which consequently leads to the expansion of the atria and them being filled with blood. Thus, it is a decreased MAPSE rather than a reduced LVEF that influences LV diastolic dysfunction [23,24]. Additionally, LV systolic twisting deformation is one mechanism by which potential energy is stored.…”

Can we diagnose isolated, exercise-induced heart failure with normal ejection fraction?

“…Many parameters, including s', e', global longitudinal and circumferential strain, right ventricular annular velocities in systole and early diastole, end-systolic elastance, and the ratio of arterial elastance/end-systolic elastance were significantly lower both at rest and during exercise in patients with HFNEF. The usefulness of the measurement of LV longitudinal systolic function was confirmed by Wenzelburger et al 36 who found a significantly lower mitral annular plane systolic excursion (MAPSE) at rest and mainly during exercise in 62 subjects with HFNEF compared to 36 control subjects. In HFNEF patients, other authors found significantly higher exercise pulmonary vascular resistance index 37 , systemic vascular resistance index 37 , lower exercise stroke volume index and cardiac index 37,38 , greater arterial stiffening 39,40 , and reduced arteriovenous oxygen difference 41,42 .…”